Fun Run Registration Form 2017.pdf
The PTA Proudly Sponsors
PS 102’s
Raising Money for
2nd Annual
Bay View 5K Fun Run/Walk Saturday, June 2017 (and3,other
activites
Where: Starting at the Memorial Pier (69th Street) Continuing along Shore Rd. bike path (Rain or Shine)
Proceeds will go to
PS 102 PTA
Check-in: 9:30-10:15 am 5K start time 10:30 am Fee: $10 per person (under 5 yrs. free) $30 per family (4 or more)
*No bikes or scooters Open to all community members Open to all Bay Ridge Members
Yes, I/we would like to run/walk: Total # of participants_________ Total $__________
*Cash/Checks accepted
Not a Runner? No Problem! Various activities will be available at the pier
No, I am not interested in participating, but would like to make a donation of:
_____ $15
_____ $50
_____ $25
_____ Other
Make checks payable to PS 102 PTA
Name(s) ___________________________________
Please send completed registration form
Phone _____________________________________
labeled “FUN RUN,” student’s name, and
Email _____________________________________ Teacher/Class_______________________________
*FORM & MONEY DUE MAY 24, 2017
and money in a sealed envelope clearly classroom teacher by May 24th For more info visit www.ps102.org Email: [email protected]
Shirt Size: Youth: ____YS ____YM ____ YLG Adult Size: ____S ____ M ____LG ____ XL ____XXL (Be sure to indicate the number of each size needed. First 200 participants who pre-register will receive shirts) Liability Waiver and Release: Upon acceptance of my entry, I, for myself, my heirs and assigns, hereby release the sponsors and officials of the PS 102 Bay View Fun Run from any liability arising from illness, or death I/we may suffer as a result of my participation in this event. I/We attest that I/we are physically fit and have sufficiently trained for this event and I/we are aware that my participation could, in some circumstances, result in physical injury. I/We give permission for free use of my name and picture in any broadcast, telecast or written account of this event. I also understand that the entry fee is NON-REFUNDABLE.
Signature _________________________________________ Date __________________
PS 102’s
Raising Money for
2nd Annual
Bay View 5K Fun Run/Walk Saturday, June 2017 (and3,other
activites
Where: Starting at the Memorial Pier (69th Street) Continuing along Shore Rd. bike path (Rain or Shine)
Proceeds will go to
PS 102 PTA
Check-in: 9:30-10:15 am 5K start time 10:30 am Fee: $10 per person (under 5 yrs. free) $30 per family (4 or more)
*No bikes or scooters Open to all community members Open to all Bay Ridge Members
Yes, I/we would like to run/walk: Total # of participants_________ Total $__________
*Cash/Checks accepted
Not a Runner? No Problem! Various activities will be available at the pier
No, I am not interested in participating, but would like to make a donation of:
_____ $15
_____ $50
_____ $25
_____ Other
Make checks payable to PS 102 PTA
Name(s) ___________________________________
Please send completed registration form
Phone _____________________________________
labeled “FUN RUN,” student’s name, and
Email _____________________________________ Teacher/Class_______________________________
*FORM & MONEY DUE MAY 24, 2017
and money in a sealed envelope clearly classroom teacher by May 24th For more info visit www.ps102.org Email: [email protected]
Shirt Size: Youth: ____YS ____YM ____ YLG Adult Size: ____S ____ M ____LG ____ XL ____XXL (Be sure to indicate the number of each size needed. First 200 participants who pre-register will receive shirts) Liability Waiver and Release: Upon acceptance of my entry, I, for myself, my heirs and assigns, hereby release the sponsors and officials of the PS 102 Bay View Fun Run from any liability arising from illness, or death I/we may suffer as a result of my participation in this event. I/We attest that I/we are physically fit and have sufficiently trained for this event and I/we are aware that my participation could, in some circumstances, result in physical injury. I/We give permission for free use of my name and picture in any broadcast, telecast or written account of this event. I also understand that the entry fee is NON-REFUNDABLE.
Signature _________________________________________ Date __________________
