5K Shamrock Shuffle Entry Form

5K Shamrock Shuffle Entry Form

PRINT AND MAIL ENTRY TO: Shamrock Shuffle

P.O. BOX 1702

Lawrence, KS 66044

PLEASE MAKE CHECKS PAYABLE TO: LAWRENCE ST. PATRICK'S DAY PARADE

Entrant Information

  Last Name:   First Name:   MI:  
  Street Address:   City:  State:   Zip:

 Day Phone #:  Email:  Shirt Size:       
 Evening Phone #:    DOB:  Age:

Suggested donations for       entry are:                          Pre-registration $20.00    Day of the race      $25.00

Amount Enclosed 

WAIVER OF LIABILITY

IN CONSIDERATION OF MY PARTICIPATION IN THIS EVENT, I, THE UNDERSIGNED, INTENDING TO BE LEGALLY BOUND, HEREBY, FOR MY HEIRS, EXECUTORS & ADMINISTRATORS, WAIVE & RELEASE ANY AND ALL CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE LAWRENCE ST. PATRICK'S DAY PARADE COMMITTEE & ANY SPONSOR/OR MEMBERS THEREOF FOR ANY & ALL INJURIES BY ME IN THIS EVENT. I HEREBY ASSUME THE RISK OF PARTICIPATING IN THIS EVENT. I ATTEST & VERIFY THAT I AM PHYSICALLY FIT & SUFFICIENTLY TRAINED FOR THE COMPETITION OF THE EVENT. I HEREBY AGREE THAT IN THE EVENT OF THE CANCELLATION OF THIS EVENT DUE TO STORM, RAIN, WINDS, INCLEMENT WEATHER OR OTHER "ACTS OF GOD" MY DONATION SHALL NOT BE REFUNDED.

SIGNATURE:                                                                                                                   

PARENT'S SIGNATURE (IF UNDER 18):