5K Form

Chaska River City Days 5K Run   

Saturday, July 30, 2016

Participant’s Name: _________________________________________

Address:_______________________________________________________

City: __________________________  State: ___________  Zip: ___________

E-mail Address _______________________________@_________________ (For future notifications of Chaska Fun Runs)

Date of Birth: __________________       Age on Race Date: ________

Gender:   ___Male     ___Female
WAIVER.  In consideration of the acceptance of this entry, I hereby, for myself and my heirs, executors and administrators, waive any and all rights. claims, and damages I may have against Chaska River City Days, the sponsors, coordination groups, and any individuals associated with said event.  Also, none of the above is responsible for neither the loss of personal items nor any aggravation in connection with said event.  I also give permission for the free use of my name and picture in any broad-cast, telecast or print media account of the event.  In filling out this form, I acknowledge I have read and fully understand my own liability and do accept the restrictions.  I also understand that all race fees are non-refundable and bib-numbers are non-transferable.  If you are under 18 years of age you must have the signature of your legal guardian to participate in this event.

Signature: _______________________________Date: _____________

Parent/Guardian  (under 18) Signature:__________________________________
Date: ___________

PRINT OUT THIS ENTRY FORM AND MAIL TO : (Check payable to Chaska RCD  Run)

Chaska RCD-5K Run
PO Box 145
Chaska  MN  55318

FEE for 5K Run:
[  ] $22.00 Early Bird registration received by 06/30/2016 **
[  ] $25.00 registration received by 07/10/2016 **
[  ] $15.00  After 07/10/16 and Race Day (Walk-Ins)
**NOTE:  Sport-Tek T-Shirt guaranteed for all pre-registered attendees received by 07/10/2016.

T-Shirt Information:
ADULT: __XSmall __Small     __Medium    __Large   __XL
__XXL (ADD $2.00 UP-CHARGE)   __XXXL   (ADD $2.00 UP-CHARGE)
WOMEN’S  __XSmall    __Small     __Medium    __Large     __XL