Professional Documents
Culture Documents
5K Entry Form
5K Entry Form
5K Entry Form
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ Detach and Mail to: Granger Emergency Services Aux, PO Box 133, Granger, IA 50109 Make checks payable to: Granger Fire Aux
Event: __________ 5k ($20 up to April 7 / $25 after) ________Real Hero Relay ($25 up
to April 7th / 30after) Name, Last:_________________________________________________ First: _________________________________ Age: ____13 & under ____14-19 ____20-29 ____30-39 ____40-54 ____55 & over Male____ Female: ____ Address:_________________________________________________________________________________________ Gender:
City:________________________________________________________ State:________ Zip: __________________ Phone: ________________________________ email: ____________________________________________________ In case of emergency, contact: ________________________________________phone #_______________________ Event: __________ 5k ($20 up to April 7 / $25 after) __________Real Hero Relay ($25 up
Youth S______
Last:_________________________________________________First: _________________________________ Shirt Size: Adult S______ M______ L______ XL______ XXL______
Last:_________________________________________________First: _________________________________ Shirt Size: Adult S______ M______ L______ XL______ XXL______
**Signatures and other information will be needed from other team members the day of the event.
*WAIVER OF LIABILITY: I understand and acknowledge that running a road race is a potentially dangerous activity that should only be undertaken by individuals who have adequately trained and are medically able. I assume all risks, whether known or unknown, associated with participating in this event including but not limited to medical emergencies brought on by physical exertion, falls, contact with other participants, effects of weather, traffic and conditions of the road, all such risks being known and appreciated by my heirs, executors and administrators, do hereby waive, release and discharge volunteers and event coordinators as well as the City of Granger, and all sponsors, their representatives and successors, from all claims and liabilities of any kind resulting from or arising out of my participation in the event including personal injury or damage suffered by me or others, even though such claims or liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Signature__________________________________________________________________ Date__________________
* Parent or Guardian must sign the waiver for anyone under 18 years (list relationship to minor)