Turn in Registration form to Coach
Hilburn by March 4th.
Make checks payable to
Lakeside Middle School Athletic Dept.
Registration fees:
5K—$25
Fun Run —$15 (no shirt)
Athlete Name
Age
Gender
Shirt Size
M /F
Shirt Sizes: Ch Sm / Ch Med / Ch Lg / Women Sm / Women Med / Women Lg / Women XL /
City
Address
Phone
Ad Sm / Ad Med / Ad Lg / Ad XL / Ad XXL .
State
Zip Code
E-mail
Registration form Due by:
3/12/2015
RELEASE: In consideration of this entry, I waive any and all claims for myself and my heirs against race officials, Five Star Nutrition, Training, & Performance, or any sponsor, for
injury or illness that may directly or indirectly result from my participation in this event. I further state that I am in proper physical condition to participate in the event. Further, I
hereby grant my permission to be photographed for the purpose of promotion, news, and information.
(Must be signed by parent or legal guardian if under age of 18)
Homeroom Teacher:
Signed:
5K Registration
$25
Fun Run Registration
$15
Date: