May 12, 2012

CY Middle School
Fun Run starts at 9:00 5k starts at 9:15
Race fees: 5k Early registration (on/before May 5th) $15 5k Registration May 6th-May 12th $20 1 mile Fun Run Registration $10 Bring FIVE non-perishable food items to race day for a $10 race fee!
All proceeds go to the continued development and support of CYs student mentoring program, WEB (Where Everybody Belongs). All food items collected will go to Joshuas Storehouse. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Waiver of Liability: I agree that by participating in the CY Get Back What You Give 5k and Fun Run, I do so at my own risk. I assume all risk of injury, illness, damage or loss to me or my property that may result, including without limitation, any loss or theft of personal property. I consent to medical treatment in the event of injury, accident and/or illness during the CY Get Back What You Give 5k and Fun Run. In exchange for accepting my entry, I agree to be legally bound, for myself, my heirs, next of kin, executors, and administrators, and voluntarily assume all risks of accident or injury and release and forever discharge, indemnify and hold harmless the CY Get Back What You Give 5k and Fun Run, CY Middle School, and the Natrona County School District from any and all liability for personal injury or property damage of any kind sustained during the CY Get Back What You Give 5k and Fun Run whether such personal injury or property damage is caused directly or indirectly by the Released Parties. I have full knowledge of the risks involved and attest that I am physically fit and sufficiently trained to participate in the 5K or 1 mile run.

PLEASE PRINT INFORMATION

5K Run ($15 if mailed by May 5, $20 if May 6 1 Mile Fun Run ($10)

th

or after, or $10 with five food items)

Name_______________________________________ Age (Race Day) ____ Male Female Address______________________________________________________________________________ City______________________________________ State_______________ Zip____________________ Phone_______________________________ Signature of Runner____________________________________________________________________ Legal Guardians Signature______________________________________________________________
(If participant is under 18 on May 12, 2012

Emergency Contact _________________________________Phone______________________________ Shirt Size: S M L XL Mail this bottom portion and check payable to: CY Middle School WEB to CY Middle School, Attn: Randy Bower, 2900 Cyclone Drive, Casper, WY 82604