.Registration Form

.Flatlander 5K/1M Trail Run

.May 7, 2011 in Lake George (40 mi. west of Colorado Springs on US Hwy. 24)

 

 

 

.Name:                                                                                                                                      DOB:                                                    

 

 

.Physical Address:                                                                                                               

 

 

.Mailing Address:                                                                                                                

 

 

.City:                                                                                                                         State:                      Zip:                                       

 

 

.Home Ph:                                                                                                Cell Ph:                                                                 

 

 

.Email:                                                                                                                                     

 

 

.Emergency Contact Name:                                                                                                  Ph:                                                        

 

 

.5K Run:                                  1Mi. Walk/Run:                                   

 

.The Run will be held rain or shine.

.Registration in non-refundable but may be transferred to another runner, at no charge.

.Proceeds to benefit: Lake George CharterSchool

 

      .Check or Money Order enclosed. Payable to: Lake George Charter School, PO Box 420, Lake George, CO 80827

                .$15.00 before May 1^st                           $8.00 for children 12 and under

               . $20.00 after May 1^st                             

                .(A $20.00 fee will be assessed for returned checks.)

 

                .9-9:45am - Race Day Registration

               . 10-10:45 (approximately) - 5K Run

                .11-11:30 (approximately) - 1M Run

 

You may support Lake GeorgeCharterSchool by donating the cost of your T-shirt.            

Please check the size shirt you will need:

.Donate T-shirt                     

.Adults:

                                 Small                                      Medium                                 Large                                      X-Large

. Kids:

                                 Small                                       Medium                                 Large                    

.There will be Participant Medals for all children 12 and under.

 

I have read the following attached RELEASE and WAIVER of LIABILITY, ASSUMPTION of RISK, and INDEMNITY AGREEMENT for the Flatlander 5K Run/Walk. I understand that I have given up substantial rights by signing it and have  signed it freely and without inducement or assurance of any nature and intend it to be a complete and unconditional release of all claims and liability to the greatest extent allowed by the law and agree that if any portion of this agreement is held to be invalid, the balance notwithstanding, shall continue in full force and effect.

 

 

 

 

                                                                                                                                                                                               

Signature of Participant                                                       Date

 

 

 

 

 

                                                                                                                                                                                               

Signature of Parent/Guardian                                             Date

 

.(Required if Participant is a minor.)

.You may email a request for registration forms to: LGschool@lgcsco.org. Forms will be emailed in return.