Clover Christmas Classic 5K

And Youth Mile

Date: Saturday, December 6
th

Location: Main St. Aomatto! "by #isitor$s Center%
Start &ime 'or 5K: (:)) am "Arrive early enou*h to *et number%
Youth Mile to start a'ter 5K race is 'inished
+ee 'or each race: ,-5.)) .ace day re*istration is ,/) and be*ins at 0 a.m.
(Make checks payable to: VCE - Appomattox) Race proceeds to benefit 4- !een "ro#rams
12nclement 3eather Date: Saturday, December -4
th

Return registration forms to 4-H Extension Office (behind courthouse) 352-8244. If you need
more information you can also email Bonnie Tillotson at btillots@vt.edu
Registrations can also be mailed to: VCE Appomattox P.O. Box 488 Appomattox, VA 24522
****** Return registration by November 21
st
to get a race T-Shirt******
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Address: 66666666666666666666666666666666666666666666666666666666666666666666
A*e on race day: 6666666666 7ender: "M% "+% Shirt si8e: Youth "S% "M% "L% Adult "S% "M% "L%
9irth date: 6666:66666:666666 ;<Mail: 66666666666666666666666666666
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Youth Mile a*e *rous: B < 0, (<-), --< -4 "=arents are Celcome to run Cith their child%
5K A*e *rous: -) ? under, --<-4, -D<-(, /)</(, 4)<4(, D)<D(, 5)<5(, 6) ? over.
ACards to the to 4 males ? 'emales in each a*e *rou. Course: Start : +inish Main St. Aomatto!:
the loo course "to be run tCice 'or 5K% consists o' rollin* hills, all aved roads,
11roads Cill remain oen11 and tra''ic Cill be controlled by volunteers.
Virginia Cooperative Extension periodically uses photographs or video or audio footage or testimonials of 4-H members for
local, regional, or state publicity or educational purposes. By my signature belo ! give permission for Virginia Cooperative
Extension to use such reproductions for educational and publicity purposes .! understand that some of the above information
is considered private. "his information ill be used for programming purposes and given to people responsible for each
program.
Signature of Participant or Parent/Guardian* _______________________________________ Date: ______________________
3avier: 2 hereby 'or mysel', my 'amily, my heirs, e!ecutors, Caive and release any and all my ri*hts and claims 'or
dama*es 2 : my child may have a*ainst #ir*inia Cooerative ;!tension, sonsors, race directors, and any other arties
involved in this race 'or any inEuries su''ered by me:my child durin* this event. 2 'urther state 2:my child is in roer
hysical condition to comete in this race.
Si*nature o' =articiant or =arent : 7uardian Date
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