Professional Documents
Culture Documents
Vezina 5k Family Fun Run/ Walk Registration Form
Vezina 5k Family Fun Run/ Walk Registration Form
Name: ___________________________________________
Sex
Male Female
Family Member #1
Name: ____________________________________________________________________________________________________
Birth Date: ______________________________________________________
Sex
Male
Female
Phone: __________________________________________________
Family Member #2
Name: ____________________________________________________________________________________________________
Birth Date: ______________________________________________________
Sex
Male
Female
Phone: __________________________________________________
Family Member #3
Name: ____________________________________________________________________________________________________
Birth Date: ______________________________________________________
Sex
Male
Female
Phone: __________________________________________________
Family Member #4
Name: ____________________________________________________________________________________________________
Birth Date: ______________________________________________________
Sex
Male
Female
Phone: __________________________________________________
Family Member #5
Name: ____________________________________________________________________________________________________
Birth Date: ______________________________________________________
Sex
Male
Female
Phone: __________________________________________________
Enclosed is our registration fee of $40 payable to Vezina Run; minimum donation to participate is
$40, if your family should choose to donate more, ALL proceeds will go to Vezina Family.
This release and waiver is signed on this date: __/__/2013. Knowingly, and at our own risk, we are participating
in the 5k Run/ Walk to benefit the Vezina Family. We waive all claims against the organizers, sponsors, and
volunteers from any claim of injury (including death) that may result due to our participation. We have
knowledge of the risks involved with the event and are physically fit and have trained accordingly to
participate.
Printed Name of Parent/ Guardian (s): ___________________________________________________
Signature of Parent/ Guardian(s): _____________________________________________________