ENTRY FORM—PLEASE PRINT
Last Name­­­____________________________ First Name____________________________
Address­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­____________________________________________________________________
City__________  Zip __________  State __________                   Sex (circle one)  M  F
DOB ____ / ____ / ____             Age (as of Nov. 15, 2008) ________
T-shirt (adult sizes – circle one)  S          M         L          XL        XXL
Phone (____) ____ - _______
Race participation (circle)    5K               1 Mile
MAKE CHECK PAYABLE AND MAIL TO:           LFHSAA
                                                                        77 SCHOOL ROAD
                                                                        LOCUST FORK, AL 35097

Waiver and release: : I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge the Locust Fork High School Alumni Association, Locust Fork High School, the Town of Locust Fork and any and all other supporting groups of this said racing event, together with all their officers, agents, officials and employees, from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event.  I further state I am in proper physical condition to participate in this event. In addition, I agree that my participation in this event requires that I will not participate with roller blades, baby joggers, skateboards, animals, or anything which the race director deems dangerous to myself or other participants and that the race director may remove me from this event for a violation of said policy.  I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion picture, recordings and any other record of this event for any purpose.  I also agree that if the event is canceled for any reason that all entry fees are non-refundable

________________________________________________                                ___________________________________________
Signature of entrant                                                                                 signature of parent or guardian if under 18