“McMinnville Fall Crawl” 5K to Benefit St. Jude
Hosted by Joshua and Ashly Crain & Main Street McMinnville
Saturday, October 29, 2011 3 PM
Please print legibly and complete the entire entry form. More than one entry may be mailed together with the appropriate fees. Please make all checks and money orders payable to Main Street McMinnville.
5K Run/Walk: $25.00 entry fee.
Kids Fun Dash: $15
COME DRESSED UP IN YOUR FAVORITE HALLOWEEN COSTUME!
First & Last Name:_________________________________________________________________________
Age on Race Day: ________ Date of Birth: ________/________/________ Male Female
City: ____________________________________ State: __________ ZipCode:________________________
Telephone: (_____)_____-________ E-mail: _________________________@_________________________
T-Shirt Size (shirts only guaranteed for first 200 registrants):
Adult S Adult M Adult L Adult XL
Registration begins at 2:00PM race begins at 3:00PM
Please Check one event: 5k Run___ 5k Walk ___Kids Fun Dash___(for kids/parents up to age 12)
Race Waiver: I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge Joshua and/or Ashly Crain, Main Street McMinnville, the City of McMinnville and any and all other supporting groups of this said racing event, together with all their officers, agents, officials and employees, from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event. I further state I am in proper physical condition to participate in this event. In addition, I agree that my participation in this event requires that I will not participate with roller blades, skateboards, or anything which the race director deems dangerous to myself or other participants and that the race director may remove me from this event for a violation of said policy. I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion picture, recordings and any other record of this event for any purpose. I also agree that all entry fees are non-refundable and that this entry is non-transferable. Thank you for participating
Signature: __________________________________________Date: _____/_____/______
Parent/Guardian Signature, if under age 18: _____________________________________________________________
Send completed entry forms to:
Main Street McMinnville
P.O. Box 373
McMinnville, TN 37111