Saturday, August 11, 2007 -- Connellsville, PA
Phil Foley Memorial 5K (iPO Event Id#: 10332) --- Return to the Details Page

Make checks payable to A.G. Montessori School
Mail to: A.G. Montessori School, 199 Edison Street, Uniontown, PA 15401

NAME__________________________________________________________________

ADDRESS_______________________________________________________________

CITY__________________________________________________________________

STATE_____________ ZIP CODE________________________________

PHONE NO.(________________)________________________________

M_____ F__________ AGE ON 8/11/07 (race day)_______________

SELECT RACE EVENT(S): 
___ RUN 5K  - (adult) ___ WALK 5K - (adult)___ Children's Fun Run - (ages 2 1/2 thru 7)

SELECT SHIRT SIZE(S): 
ADULT: Small___ Med___ Lg___ XLg___ XXLg___ CHILDREN'S: 6-8___ 8-10___ 

THE FINE PRINT (please read before signing)
Please enter me and/or my child in the Phil Foley Memorial 5K run, walk, or children's fun run on August 11, 2007. In consideration of the acceptance of this application and intending to be legally bound, I hereby waive, discharge, and release myself and my heirs, successors, administrators, and executors, of any and all claims, damages, and causes of action of what so ever kind including negligence, that I may have against the A.G. Montessori School, it's representatives, successors, administrators, and executors, asides, trustees, and parent subsidaries or affiliated companies if any for all injuried suffered by me and/or my child in these events. Further, it is agreed that I release the rights to the unconditional use of whatever photographs/pictures I/we might be a part of, without remuneration or compensation or any kind.

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SIGNATURE                                            DATE

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SIGNATURE OF PARENT/GUARDIAN if under 18             DATE