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TRACK & FIELD AND
CROSS-COUNTRY RUNNING

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5K FUN RUN  Application form

Please provide the following  information:

Last Name
First Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail

Enter your birthdate                          Sex      Male     Female

-- mm/dd/yy                                

           I know that cross-country running is a potentially hazardous activity. I should not enter this race unless I am medically able and properly trained. I assume all risks associated with running in this race. In consideration of this entry being accepted, I, for my self, my heirs and administrators, hereby waive any claims I may have against the Burlington High School and Burlington School District, organizers, sponsors or anyone connected with this event for any injury, damage, or loss of property during the conduct this event.

I accept 

Enter today's date

-- mm/dd/yy

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Copyright © 1999 [Pavel Dvorak]. All rights reserved.
Revised: January 05, 2001 .

BURLINGTON HIGH SCHOOL

Phone: 802 864 8588

52 Institute Road

Fax: 802 865 5305

Burlington VT, 05401

A.D.Phone: 802 864 8589

U.S.A.

E mail: pdvorak@burlhs.k12.vt.us