Sat, June 16, 7:00am (Register at 6:30 am-$10 fee)
Start at Larrick Park Basketball Court
Water/granola bars/fruit provided and you'll get an earth friendly gift at the finish!
To pre-register, answer the following questions, complete, print and sign the release form, and mail them with your $10 to
City of Lenora, Attn: Tonya Juenemann
125 E Washington, Lenora, KS 67645
Must be age 16 or accompanied by an adult
Choose one: 3 mile or 5 mile
Full Name
Age
Sex
Date of Birth
Evening Phone
Day Phone
Email
Mailing Address
LIABILITY RELEASE FORM
On this __________ day of ____________________, 200_____, intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and to indemnify and hold harmless City of Lenora, or any involved in arrangement of event and any of its employees or agents representing or related to the Annual Charity Event as regards to the walk/run. This release is for any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity or accommodations for this event. The undersigned further agrees to abide by all the rules and regulations promulgated by City of Lenora and/or its affiliate groups.
________________________________ ________________________
Guest Name (please print) Date Signed
_______________________________
Signature of Guest Participant
________________________________
Signature of Parent/Guardian (if under 18)
.