Color Fun Run
WITH ROME GRADE SCHOOL PTO Color Fun Run registration at 8:00 a.m. Color Fun Run race at 9:00 a.m. April 29, 2017 Location: Dix Community Park Dix, IL 62830 Proceeds:
The proceeds from the race will go to the Rome Grade School PTO.
Registration:
Color Fun Run $25 – High School Students and Adults $15 – 8th grade and below
T-shirt:
Given out on race day if pre-registered by March 27, 2017
Contact:
For additional information please contact: Amy McKinney (PTO President) at (618)980-8249 or email at: [email protected]
_____________________________________________________________________________ PLEASE PRINT ALL INFORMATION – ONE ENTRY PER FORM Make checks payable to: Rome Grade School PTO Mail to: 233 W. South St. Dix, IL 62830 T-SHIRT SIZE: Youth: S M L
Adult: S M L XL XXL 3XL
NAME:______________________________________________ PHONE NUMBER:___________________ ADDRESS:_________________________________________________ CITY:_________________________ STATE, ZIP:_______________________________
GENDER: Male
Female
DATE OF BIRTH:_________________________________ AGE ON RACE DAY:_________ WAIVER OF LIABLITY: I hereby release the hosts, sponsors, volunteers, and officials of the Color Fun Run from claims of injury or illness, which may result directly or indirectly from my participation. I further state that I am in proper physical condition to participate in this event. I also give permission for my name and photograph to be used in any media or account of this event.
SIGNATURE:________________________________________________ DATE:______________________ (Parent or guardian signature if under 18)
Would you like to be a volunteer day of race?
YES
NO
The proceeds from the race will go to the Rome Grade School PTO.
Registration:
Color Fun Run $25 – High School Students and Adults $15 – 8th grade and below
T-shirt:
Given out on race day if pre-registered by March 27, 2017
Contact:
For additional information please contact: Amy McKinney (PTO President) at (618)980-8249 or email at: [email protected]
_____________________________________________________________________________ PLEASE PRINT ALL INFORMATION – ONE ENTRY PER FORM Make checks payable to: Rome Grade School PTO Mail to: 233 W. South St. Dix, IL 62830 T-SHIRT SIZE: Youth: S M L
Adult: S M L XL XXL 3XL
NAME:______________________________________________ PHONE NUMBER:___________________ ADDRESS:_________________________________________________ CITY:_________________________ STATE, ZIP:_______________________________
GENDER: Male
Female
DATE OF BIRTH:_________________________________ AGE ON RACE DAY:_________ WAIVER OF LIABLITY: I hereby release the hosts, sponsors, volunteers, and officials of the Color Fun Run from claims of injury or illness, which may result directly or indirectly from my participation. I further state that I am in proper physical condition to participate in this event. I also give permission for my name and photograph to be used in any media or account of this event.
SIGNATURE:________________________________________________ DATE:______________________ (Parent or guardian signature if under 18)
Would you like to be a volunteer day of race?
YES
NO
