Timberwolf 5K - Online Registration Form

Online Registration Form: Timberwolf 5K

Race Category

Early Registration
(by Feb. 15)

Registration Fee
(after Feb. 15)

Event:

5K Run

$25.00

$30.00

5K Walk

$25.00

$30.00

5K Run NHS Student/Faculty

$20.00

$25.00

5K Walk NHS Student/Faculty

$20.00

$25.00

1K Fun Run/Walk

$15.00

$20.00

1K Kids Run (age 12 and under)

$15.00

$20.00

Name:*

First:*

* required

MI

Last:*

* required

Gender*

Birthdate*

Email:

Phone #:*

Day Phone:*

* required

Evening Phone:

Cell Phone:

Address:*

No. & Street:*

* required

Apt. #:

City:

   State:

* required

ZIP:

* required

Country:

Tee Shirt Size:

(Navy blue tee shirt with Timberwolf 5K logo)

ADD DONATION TO "FAMILIES FORWARD":

Total Enclosed:

Check No:

Select Credit Card Type:

Write credit card number in the boxes below after printing this form.

Expiration Date:

Security Code:

CARDHOLDER SIGNATURE:

__________________________________________________________________

WAIVER:
I am aware that participating in athletic events may involove some risks or injury. I herby voluntarily assume all risks associated with participation and agree to exonerate and save harmless Northwood High School (NHS), their agents, servants, employees, the NHS Athletic Boosters Club, the physicians, athletic trainrs, and other practioners of the healing arts treating me from any and all liability, claims, causes of action or demands of any kind and nature whatsoever which may arise by or in connection with participation in any activities related to Timberwolf 5K Run/Walk. The terms hereof shall serve as a release and assumption of risks for my heisr, estate, executor, administrator, assignees and all members of my family.

PARTICIPANT'S SIGNATURE:

(Parent's signature if entrant is under 18 years of age)


____________________________________

Date:


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