WALK RUN BIKE
To benefit the Sturgeon Community Teachers Association (CTA)
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Adult Participant 1:
Check one: ______5K EventParticipantAge 18 or older ______Phantom Runner(t-shirt only)
Print Full Name of Age 18 or older Registrant: ______
Cell Phone Number or Land Line Phone Number :______
Street Address: ______
City, state, zip code ______
Email Address ______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL
Youth Medium Youth Large Youth XL
Sorry, no shirts smaller than youth medium
Adult Participant 2:
Check one: ______5K Event Participant Age 18 or older ______Phantom Runner (t-shirt only)
Print Full Name of Age 18 or older Registrant: ______
Cell Phone Number or Land Line Phone Number :______
Street Address: ______
City, state, zip code ______
Email Address ______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Youth Medium Youth Large Youth XL
Student/Child Participant:
Check one: ______5K Event Participant ______Phantom Runner (t-shirt only)
Print Full Name of Registrant: ______
Age & Date of Birth:______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Youth Medium Youth Large Youth XL
Student/Child Participant:
Check one: ______5K Event Participant ______Phantom Runner (t-shirt only)
Print Full Name of Registrant: ______
Age & Date of Birth:______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Youth Medium Youth Large Youth XL
Student/Child Participant:
Check one: ______5K Event Participant ______Phantom Runner (t-shirt only)
Print Full Name of Registrant: ______
Age & Date of Birth:______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Youth Medium Youth Large Youth XL
Student/Child Participant:
Check one: ______5K Event Participant ______Phantom Runner (t-shirt only)
Print Full Name of Registrant: ______
Age & Date of Birth:______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Youth Medium Youth Large Youth XL
Student/Child Participant:
Check one: ______5K Event Participant ______Phantom Runner (t-shirt only)
Print Full Name of Registrant: ______
Age & Date of Birth:______
T-shirt size (circle one): Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Youth Medium Youth Large Youth XL
RELEASE --WAIVER OF LIABILITY OF 5K EVENT PARTICIPANT: I, the undersigned 5K Event Participant, am 18 years of age or older and know that walking, running, or biking on public streets and roads is a potentially hazardous activity. I understand I should not participate in the 5K Event unless I am medically able and properly trained. I assume all risks associated with walking, running, or biking this 5K Event. Having read this and knowing these facts and in consideration of the Sturgeon Community Teacher Association (CTA) accepting my entry fee, I, the undersigned, for myself, my heirs, personal representatives, guardians, legal representatives and assigns, do hereby release from liability and agree not to make or bring any claim or lawsuit of any kind, including any claim for property damage, against the CTA organization, Sturgeon, Missouri School District, the City of Sturgeon, Missouri and/or all event sponsors, and/or the officers, agents and employees of any such legal entities and organizations, for all legal claims and liabilities of any kind which may be sustained or suffered by the undersigned in connection with or arising out of participation in this event. I, the undersigned, further agree to hold harmless and fully indemnify each legal entity and person released herein who incurs or pays any such damages or claim, or any costs relating thereto, including attorney fees.
______Signature of 5K Event Participant (Age 18 or older) DateSigned
Registration form and entry fee may be returned or mailed to: Cindy Kempker, Sturgeon Schools, 210 West Patton Street, Sturgeon, MO 65284. Please make checks payable to Sturgeon SchoolsCTA.
Questions: Contact Cindy Kempker at