Online Registration Form:  Timberwolf 5K
	Race Category				Early Registration (by Jan. 29)		Registration Fee (after Jan. 29)
Event:	5K Run				$30.00		$35.00
	5K Walk				$30.00		$35.00
	5K Run NHS Student/Faculty				$25.00		$30.00
	5K Walk NHS Student/Faculty				$25.00		$30.00
	1K Fun Run/Walk				$20.00		$25.00
	1K Kids Run (age 12 and under)				$20.00		$25.00
Name:*	First:*  * required			MI	Last:*  * required
Gender*	Female Male			Birthdate*	MM 01 02 03 04 05 06 07 08 09 10 11 12	DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	YYYY 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930
Email:
Phone #:*	Day Phone:*  * required			Evening Phone:		Cell Phone:
Address:*	No. & Street:*  * required			Apt. #:	City: Irvine Lake Forest Tustin Rancho Santa Margarita
	State:  * required			ZIP:  * required		Country:
Tee Shirt Size:	(Navy blue tee shirt with Timberwolf 5K logo) Adult Small Adult Medium Adult Large Adult XL Adult XXL Youth Medium Youth Large
Total Enclosed:				Check No:
A portion of the money raised for the Timberwolf 5K Run/Walk will be donated to "FAMILIES FORWARD".  We encourage you to make a personal donation to Families Forward at:  www.Families-Forward.org/donations.htm.
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 staff, NHS Athletic Boosters Club, the physicians, athletic trainers, 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 heirs, 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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