Spirit Run & Walk - September 26, 2004
Web Entry Form
Check event:   r5K Run      r5K Family Walk

First name_______________________  Last name_____________________________________
Address______________________________________________________________________________________
City___________________________________    State________    ZIP_____________
Phone - day _________________________      Phone - evening __________________________
E-Mail _____________________________________________________________________
 Spirit Entry Name  in honor of someone who has touched my life _________________________
Spirit Contribution in honor of someone who as touched my life  $_____

Sex:  r Male   r Female            Age:_____________   T-Shirt size  q M q L q XL  q XXL
 q $20.00 5K run or walk (entered by Sept. 17)   q $25.00 After 9/17
WAIVER (Must be signed)

I know that running and walking a road race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abideby any decision of a race official relative to my ability to safely complete the run or walk. I also know that while police protection will be provided, there may betraffic n the course. I assume all risks associated with my voluntary participation in this event, including, All but not limited to, falls, contact with other participants,the effects of the weather, including extreme cold, snow, and ice, traffic, and the conditions on the road, al such risks being known and appreciated by me.Knowing these facts, and in consideration of you accepting my entry, I for myself, my heirs, executors, administrators, or anyone else who might claim on mybehalf, covenant not to sue and WAIVE, RELEASE and DISCHARGE: University High School, TrueNorth and Associates, Rock Solid Results, and Tuxedo Brothers,volunteers. Village of West Clay their representatives, successors or assigns from ANY AND ALL claims or liability, whether foreseen or unforeseen, for death,personal injury or property damage arising out of, or in the course of my participation in this event.I further grant full permission to The event coordinators and volunteers and/or agents authorized by then, to use any photographs, video tapes, motion pictures,recordings or other record of the event for any reasonable purpose. I understand that my entry is non-refundable.

______________________________________________________________________
Signature of Entrant Date
Signature of Parent or guardian if entrant is under 18 years old.
Send check or money order payable to UNIVERSITY HIGH SCHOOL to:
Tuxedo Brothers, 6265 Boone Ridge, Zionsville, IN 46077. 
All mailed entries must be postmarked by September 16.