Jingle Bell Jog 5K Registration Form

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JINGLE BELL JOG 5K

Carlow Regional Youth Services in conjunction with Co. Carlow LSP

Sunday 8th December, @ 11.00am from Carlow Rowing Club

Registration Form
Please complete in Block Capitals & return to: CRYS, Montgomery street, Carlow. Name: Address: Age: Telephone: Email: Male Female:

Organisation you wish to support: Registration fee before Wednesday 4th December, 12 & U18s 5. Fees on the day 15 / adult. Registration on the day from 10am to 10.30am
Declaration: Please enter me for the above event for which I enclose the appropriate fee. I understand that the organisers of the event will not be held liable for injury, loss or illness, howsoever occasioned, resulting from the event. By signing this form I also give my consent for photographs or videos to be used for media purposes.

Signed: Parent/Guardian if Under 18 years of age:

Date:

CRYS: 059 9130476

www.carlowys.ie

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