1St Annual Crown and Sash Dash

1st Annual Crown and Sash Dash

July 18th, 2015

Kewaunee County Fairgrounds, Luxemburg WI.
Proceeds benefit: Kewaunee County Fairest of the Fair Program

Registration Form: Make checks payable to: Kewaunee County Fair/ Crown and Sash Dash

Mail form & checks to: Crown and Sash Dash- 108 West Ave. Casco, WI. 54205

Name: Gender: Birth date: T-shirt size: (circle one)

______Youth: S (6/8) M (10/12) L (14/16) XL (16/18) Adult: S M L XL 2XL 3XL 4XL

______Youth: S (6/8) M (10/12) L (14/16) XL (16/18) Adult: S M L XL 2XL 3XL 4XL

______Youth: S (6/8) M (10/12) L (14/16) XL (16/18) Adult: S M L XL 2XL 3XL 4XL

______Youth: S (6/8) M (10/12) L (14/16) XL (16/18) Adult: S M L XL 2XL 3XL 4XL

Consent and Liability Waiver: I assume all risk and injury to me and all registrants on this entry form due to the participation in the Crown and Sash Dash. On behalf of myself, the aforementioned registrants, and any associated heirs and executors, I waive and release any all claims against the race sponsors and volunteers, the Kewaunee County Fair Board, Kewaunee County Fairest of the Fair program, Kewaunee County, and the Village of Luxemburg. I verify that all of registrants on this entry form are physically fit to compete in this event. Photograph Authorization: I hereby give the Kewaunee County Fair and its affiliates, permission to photograph me during the run and its related activities, and to use those photographs for any purpose, including but not limited to commercial purposes, Kewaunee County Fair advertisements and promotional materials. As a participant in the Crown and Sash Dash, I understand I may become ill or injured and medical treatment may be necessary. I give consent to staff and/or volunteers to evaluate, treat injuries/illnesses, and activate emergency care as indicated.

Registration: Family must reside at the same address (only 4 family members per family registration)

– List names and ages and shirt sizes on the back of the form.

Race packets may be picked up on Saturday morning at the Exhibition Building from 6:30am-7:45am

Prior to (July 1st) $20 Individual ______$40 Family of 4 ______

After July 2nd registration: $25 Individual ______$50 Family of 4 ______

Address: ______City/St/Zip: ______

Email: ______Phone: ______

Signature/Participant: ______Date: ______Parent (if under 18): ______

Signature/Participant: ______Date: ______Parent (if under 18): ______

Signature/Participant: ______Date: ______Parent (if under 18): ______

Signature/Participant: ______Date: ______Parent (if under 18): ______

Register online at www.active.com download additional forms at

www.kewauneectyfair.com click on the Crown and Sash Dash link.

Questions? Email: or