Please download this form, fill in and sign, mail with a check or bring along on race day:

Geogia Lions Club 5K Fun Run/Walk for Childrens Sight

Join us for our first annual Fun Run/Walk. We are your local Lions Club serving the Georgia community. We purchase glasses for children & adults, support the local Little league, Babe Ruth, books for children, childrens peace poster contest, Christmas memory tree, families in need, and other worthy causes.

First Name _____________________ Middle Name ________________

Last Name _______________________ Gender ____________________

Age Group 5-19( ) 20-39 ( ) 40-59 ( ) 60+ ( )

Birthday: _______________ email: ________________________________

Phone: ___________________ Address: ____________________

City/Town: ______________________ State: ____________ Zip: ____

Kids under 10 1/2 Mile Free.    All others $10.

In consideration of your accepting my entry, I, the undersigned, intending to be legally bound, for myself, my executors and administrators, waive and release any and all rights and claims for damages I may have against the race organisers, sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will participate in this event as a foot race, that I am physically fit and sufficiently trained for the completion of this event.

Signature _______________________________________

Parent Signature (under 18)_________________________

Send to Georgia Lion Club, 258 Carpenter Hill RD, St. Albans, VT. 05478