Families for Youth 5K Walk
REGISTRATION FORM
NAME:
ADDRESS:
CITY, STATE, ZIP
PHONE
AGE SEX
EMAIL
ADULT T-SHIRT SIZE:  S   M   L   XL   2XL
CHILD T-SHIRT SIZE:  YOUTH S   ADULT S   ADULT
(14 & Under) (ONLY ONE T-SHIRT PER PARTICIPANT)
ARE YOU PART OF A TEAM?

REGISTRATION FEE $
$25.00 Adults $10.00 Children (14 & Under) Until October 17th
$30.00 Adults $15.00 Children (14 & Under) After October 17th
I know that running/walking a road race is a potentially hazardous activity and that I should not enter and run/walk unless I am medically able and properly trained. I agree to abide by any race official including, but not limited to: falls, contact with other participants, the effects of the weather, including low or high temperatures and/or humidity, traffic and the conditions of the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, myself, and anyone entitled to act on my behalf, waive and release the Downey Side and Point Pleasant Beach, NJ and any other race sponsors, its Officers, members and race volunteers from any and all claims and liabilities of any kind arising out of my participation in this event or carelessness of the persons named in this waiver, I further grant all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purposes.
*I agree to the terms above
Register by Mail
Fill out and mail entry form along with your payment to Downey Side, P.O. Box 1593, Pt. Pleasant Beach, NJ 08742
DOWNEY SIDE
42O RICHMOND AVENUE • POINT PLEASANT, NJ 08742
TAX ID# FID EO-042-441-463/000


I CANNOT PARTICIPATE IN THIS COMMUNITY EVENT, BUT I WOULD LIKE TO MAKE A TAX DEDUCTIBLE DONATION TO THE DOWNEY SIDE ADOPTION AGENCY IN THE AMOUNT OF $

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