Last Name:       

Mailing Address:       

                     City:       

                   State:

             Zip Code:       

              Country:

                 Phone:       

   Email Address:       

Age on Race Day:       

     Date of Birth:        _ _/_ _/_ _ _ _

              Gender:        Select One Male Female

                 Event:        Select One 5K Run 10K Trail Run 2 Mile Walk Half Mile Kids Run 5-12

           Shirt Size:        Select One Adult Extra Small Adult Small Adult Medium Adult Large Adult X-Large XX Large Add $2.00 XXX Add $3.00

Full Waiver & Release

In consideration for my entry being accepted, I hereby waive and release forever for myself and for my heirs, executors, administrators, any and all claims, causes of actions and suits I may accrue against the Springville Community Club, Springville, County of Tulare, property owners on whose property the race is run, race director, race volunteers and any sponsors of this race for any bodily injury, emotional injury, property damage or economic loss, including death, suffered by me while traveling to and from or competing in the Springville Apple Run 5K Run, 10K Trail Run, 2 Mile Walk or Half Mile Kids Run on October 17, 2009 whether from natural hazards, human-made hazards, actions or inactions of third parties, or any other defect or omission or act.

I accept the full waiver and release: Select Yes

              I accept on behalf of minor: Select Yes

                                          Electronic Signature.  Please Type Name.
          Signature:     Signature Required for all Participants.  Parent or Guardian must sign for Minor.

Name of Minor:

                  Fees:        Select One Adults Youth 12 and Under Seniors 60 and Over

Online Registration Is Now Closed