5K Labor of Love and Kids 1K
Downers Grove Noon Lions
2011Registration Form
Cost: Adult $30, Youth $23 (16 years or younger), Families $85 (5 immediate family) , Kids 1K $15, CARA members receive $5 discount (This is a CARA certified event)
Make checks payable to: Downers Grove Noon Lions
5K Race Starts 8AM, Labor Day (Kids 1K starts at 9AM) Sept 5, 2011, McCullomPark, 6701 Main St.Downers Grove60516
Mail to: Downers Grove Noon Lions
c/o Lion George Swimmer
4905 Main Street
Downers Grove, IL60515
Or Fax to: (630) 810-9222
Print Name______Phone______
Email (important print clearly)______
Address______City/State______Zip______
Date of Birth ______Age _____ Male ______Female______
Adult T-Shirt Sizes S___M__L__XL__ XXL___ Kids Sizes S__ M__ On race day shirts will be available ONLY while supply lasts. Will you need a guide? Y__N__ What accommodation will you need, if any? ______Will you use a wheel chair? Y__N__
Payment: Check Number______Amount $______5K_____ 1K______
Additional donation to help the humanitarian efforts of the Downers Grove Noon Lions Club $______
Waiver:
A physical examination is not required to run in this event, however, all competitors participate at their own risk. If in doubt as to your physical condition to engage in an event as strenuous as a 3.1 mile run, it is strongly recommended that you seek the advice of a competent physician. All persons under 18 years of age MUST have written consent from their parent or legal guardian to compete in the above mentioned event. In consideration of this entry, I hereby, for myself, my heirs, executors, and administrators waive any and all rights to damages I may have against the Downers Grove Noon Lions Club. Village of Downers Grove, Downers Grove Park District, individuals associated with the event, their representative, successors and sponsors for any and all injuries including, but not limited to, pre-race, race, and post-race activities. No refunds. Race will take place rain or shine.
Signature (Applicant)______Date______
The undersigned parent or legal guardian consents to the applicant’s participation and releases all rights and claims set forth above.
Signature (Parent/Legal Guardian
______Date______