First Name:

       Address:

              City:

            State:

                Zip:

           Phone:

            Email:

Date of Birth:

            Event:    Select One 10 M Diaper Crawl 50 M Princess Dash 200 M Princess Dash 400 M Princess Dash Two Mile

  Child Registration 12 & Under Child‘s discount is $5 with a paid adult

     One Mile Talk N Walk We encourage ALL female entrants to participate

       Shirt Size: Select One Youth XS Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL

In consideration of the acceptance of this registration entry, I the undersigned assume full and complete responsibility for any injury or accident, which may occur during my participation in the event or while I am on the premises of the event. I hereby release and hold harmless Journey To The CORE, LLC & Events, Sherryl Zoltenko, Superior Public Schools, the coordinators, the sponsors, promoters and all other persons and entities associated with the event or their agents or employees, or otherwise. I will not enter and participate unless medically and properly trained. I also know that although police protection will be provided, there may be traffic on the course route. I assume the risk associated with this event, including but not limited to falls, contact with participants, alcohol consumption, the effects of weather including high heat and/or humidity, and the conditions of the road, all such risks being known and appreciated by me. I further grant my permission to use any photographs, videotape, motion pictures, recordings, or any other record of this event. Fees are non-refundable. T-shirt size is not guaranteed. I have read the forgoing and certify my agreement by this signature, and my parent's/ guardian's if under 18.

          Waiver:   Select One Yes

       Signature: Must be signed by parent/guardian if participant is under 18.