__________________, ___________________
First Name, Last Name
__________________, ___________________
Mailing Address, City
__________________, ___________________
State, Zip, Phone
Age:1-12___,13-18___,19-29___,30-39___,40-49___,50-59__, 60&up___.
Fun Run Ages:1-6__,7-12__,13-17__,18&up___
Run: 5K___, 10K___, Fun Run___
Sex: Male___ Female___
T-Shirt:Youth L, Sm___,Med___,Lg___,XLg___,Other___
Waiver of Liability: I hereby release Granite Co. Museum & Cultural Center, all committee members, and all volunteers from any and all liability including medical claims which may arise from my participating in these events.
_____________________________ Signature (required)
_____________________________ Parent/Guardian if under 18