Kiwanis Park---Lewiston, Idaho

Race Sponsored by LCSC Cross Country

· Runs will take place on the Lewiston/Clarkston Greenbelt

· Race Day Registration will open at 6:00pm.

· COSTS: PRE-REGISTERED - - $8.00 (No Shirt), $12.00 (With Shirt)

AFTER April 9 - - $10.00 (No Shirt), $16.00 (With Shirt)

· For more info contact Mike Collins at 208-792-2308 or Mcollins@lcsc.edu

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Registration Form (Please Print)

Name:____________________________ Age:____ Gender: M or F

Address:_____________________City:____________State:_____Zip:______ Phone:_________

SHIRT SIZE (IF APPLICABLE): ___S ___M ___L ___XL

Please read the following statement and sign below before submitting entry.
I know that competing in a fun run is a potentially hazardous activity. I should not enter and compete unless I am medically able and properly trained. I assume all risks associated with competing in this event, including, but not limited to falls, contact with other participants, the effects of weather, traffic, interactions with non-participants and the conditions of the road all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of the acceptance of my entry, I, myself and anyone entitled to act on my behalf, waive and release any and all sponsors and organizers, their officers, agents and assigns, the race director and volunteers from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of the negligence or carelessness on the part of the persons named in this waiver. I also understand that my entry fee is non-refundable and non-transferable. A parent must sign if the child is under 18 years of age. This certifies that the child has permission to participate and agrees to the previously stated waiver.

Signature: _________________________________ Date:__________

Parent/Guardian (if under 18 years of age): ____________________________Date: __________

Mail Entry Form and Fees to:

Mike Collins
LCSC Cross Country
500 8th Avenue
Lewiston, ID 83501

Make checks payable to LCSC Cross Country