& 1 mile run
November 2, 2013
It's A Superhero Race, wear your favorite costume, including your cape, join us in November.
Last Name __________________________ First Name ________________________
Gender ____ Age ____ Date of Birth ____/____/____
Address _________________________ City __________ State ____ Zip __________
Email Address ___________________________ Phone Number _________________
Cost: $25 Prior to midnight October 15 (fee includes breakfast & shirt)
$30 After October 15 $20 for all Students
What race are you signing up for: 5K run ___ 10K run___ 1mile run ___ 1mile walk ____
T-Shirt Size: ________ Donate my $ to (GHSO student name): _________________
One breakfast included per runner, additional breakfasts for fan club: ($5 each) ______
Wear a cape to honor your superhero.....
In submitting this entry, I, intending to be legally bound for myself, my heirs, executors, and administrators waive, release and forever discharge any and all rights and claims for damages I have or may have against the organizers of this event, its principles, its employees, its volunteers, all sponsors and their representatives for any and all claims and damages, demands actions whatsoever in any manner, as a result of my participation in The GHS 5K/10K Pancake Run, including travel to and from the event. I hereby consent to medical treatment in the event of injury, accident and/or illness during the event. I hereby grant full permission to any and all of the foregoing to use my name and likeness in any broadcast, telecast, video or print media reporting or advertising of the event without compensation. If you are under 18, a parent or legal guardian must sign this form.
PRINT NAME _______________________________________ DATE _____________
SIGNATURE (Guardian to sign if under 18) ___________________________________
Make checks Payable to: Gilbert Orchestra Boosters
Mail to: Arloa Van Drew, Gilbert Orchestra Boosters,939 E Desert Lane Gilbert AZ. 85234