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5K Run

Click Here to view and print the event flyer

First name:
Last name:
Email Address
Address:
City:
State:
Zip:
Phone:
Gender:
M F
 
Age on 5/5/2010:
 
Events (choose one):
5K Walk
5K Run  
Fun Run (kids 12 & under)
             
T-shirt Size (choose one):
S
M  
L  
XL   XXL   Youth M   Youth L
 
Please enter fee enclosed:
$
 
I am not able to participate, but willing to donate:
$

 

Please mail checks to:

Grant CCSD #110
Attn: Education Foundation
9950 Bunkum Road
Fairview Heights, Illinois 62208


Please make checks payable to:

Grant CCSD #110

Waiver of Liability:

In consideration of the acceptance of my registration to participate in said program, I agree to indemnify and save harmless Grant CCSD #110, its agents, servants, and employees, from and against any and all damages arising from injuries to persons or damage to property occasioned by any acts or omissions of participant, its agents, servants, or employees, in defense of any claim, action or suit, irrespective of any claim that an act, omission or negligence of the school or its agents, servants, or employees contributed to such injury or damage. I understand that the registered activities and services may have an element of hazard or inherit danger and I take full responsibility for my actions and I acknowledge that I am physically fit and sufficiently trained to participate in the event. I also waive my right to any photographs that may be taken to publicize school activities.

Grant District 110 Education Foundation
10110 Old Lincoln Trail
Fairview Heights, Illinois 62208

Phone: 618-398-5577
Fax 618-398-5578

 

 

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