2016 5k For Labor Day Registration Form

Page 1

Professional Timing Service!

At Independence Grove 16400 W Buckley Rd, Libertyville, IL Finish Line Celebration Medal to every participant

Also register online: www.waukegantownship.com

Trophy to winners in each category!

Register in Person: 5K for Labor Day Headquarters, Park Place 414 S. Lewis Ave., Waukegan, IL Registration day of event at race site: 7:00 a.m. - 8:45 a.m. / 9:00 a.m. - Race

This is your registration form. You may mail this form and payment prior to the event or bring to the event. Mail to: 5K For Labor Day Headquarters 414 S. Lewis Ave., Waukegan, Il 60085 - 847-244-9242.

Name________________________________________________________________________ Walker________ Runner______ M/F____ Competition, Timing and Bib Needed___________ Mailing Address________________________________________________________________ Email______________________________________ City______________________________________ State___________ Zip_________________ Phone_______________________________ Date of Birth_______/________/______ Make Checks Payable to Waukegan Township CARES Cash/Credit Card; Paypal

I plan to Walk/Run. Will sign waiver below:

*Please include T-Shirt size: XXL / XL / L / M / S

Donation only. Will pick up T-Shirt

WAIVER: I hereby waive all claims against Waukegan Township CARES, Waukegan Township, Lake County, Lake County Forest Preserve, Independence Grove, sponsors, or for personal injury I might suffer in this event. I attest I am physically fit and prepared for this event. Signature__________________________________________________________________________________ Date________________________________ Parent Consent for Minors/Sign_____________________________________________

For Office Use Only: ___ ___

Registered via website. Registered by Township staff.

Call 847-244-9242 or email Lpable@waukegantownship.com for more information


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