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Saturday, April 30, 2011 -- Morgantown, WV / Jack Roberts Park, First Ward
Parents Place 5K Run/Walk (iPO Event Id#: 13329)

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RACE CONTACT: Adrian Kettering (phone) 304-685-7192

Entry Fee: If you register before April 18, 2011, the registration cost is $18.00. All entrants who register after April 18 will be charged $20.00. Fees are nonrefundable. Please make checks payable to: Parents' Place.

Make checks payable to: Parents' Place

Mail to: Parents' Place, 105 Summit Overlook Drive, Morgantown, WV 26508

Name:____________________________________________ Phone:_______________________

Address:__________________________________________ Date of Birth:_____________

Age as of 4/30/11:________ / Male:___ or Female:___

T-shirt size: Small:___ / Medium:___ / Large:___ / X-Large:____

Please check your choice for the event: Running_________ or Walking__________

In consideration of your acceptance of my application for entrance in the Parents' Place 5K, I, for myself and anyone entitled to act on my behalf, waive and release Parents' Place and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I release any photos that may involve myself:

Signature: ___________________________________________________________________

Date: __________________

Entrant's Signature Parent of Guardian, if under 18:

Signature: ___________________________________________________________________

Date: __________________