ENTRY FORM WAIVER
Name_______________________________________________________
Date of Birth ____ / ____ / ____
age as of 6/16/2002_________ M / F (circle one)
Address____________________________________________
City_________________________________________________ State___________
Zip__________
Run_____ Walk____
Shirt Size: (M)____ (L)____ (XL)____
Area High School _____________________________________
_____ Student , _____ Teacher , _____ Staff
____Pre-Registration $10.00 ____After June 9th $15.00
Please submit this form no later than June 9th, 2002
to: Kilbride Family Classic 5K Road Race and Walk , P.O. Box 921, Kankakee, Il 60901
Make checks payable to: Kilbride Family Classic 5k For further information call (815) 937-4200 days or (815) 932-3885 after 6:00pm.
I waive and forfeit all rights , I, my heirs, successors or assigns may have to file suit against the KILBRIDE FAMILY CLASSIC 5K and it's sponsors.
Signature_________________________________________
Parent Signature (under 18) __________________________