downloadable entry form

7TH ANNUAL
JEFF DROPO
RUN 4 KIDS
BBENEFITING
1985
celebrating 30 YEARS of smiles
Alabama‛s Program for Children with Cancer
2015
SATURDAY MAY 9, 2015
5K RUN 8:00 AM - 1M WALK 9:15 AM
Florence High School • 1201 Bradshaw Drive • Florence, AL
JEFF DROPO RUN 4 KIDS ENTRY FORM
Name:_______________________ Address:__________________________________
City:____________________________________State:_________Zip:_____________
Phone:__________________________ Email:_________________________________
Age:_______ Birth date:___________ Emergency Contact:________________________
Circle one:
Male
Please Circle T-shirt size:
Phone:________________________________
Female
YS
YM
YL
AS
AM
AL
AXL
I know that running a road race is potentially hazardous activity. I should not enter and run unless I am medically stable and properly trained.
I agree to abide by any decisions of a race official relative to safely completing the run. I assume all the risks associated with running in this
event but not limited to fall, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and other
road conditions, all such risks being known and appreciated by me. Having read this waiver and knowing those facts and in consideration
of your accepting my entry, I for myself and anyone else entitled to act on my behalf waive and release American Promotional Events Inc.,
TNT Fireworks, Camp-Smile-A-Mile, the City of Florence, Florence City Schools and all run/walk volunteers and organizers, all sponsors,
their representatives and successors from all claims in liabilities of any kind arising out of participation in this event. I grant permission to
all of the foregoing to use photographs, motion picture recording or any other record of this event for legitimate purposes.
Signature:_____________________________________________________________________________
(Signature of parent if under age 18)
Date:____________________________
Mail Checks (payable to Camp-Smile-A-Mile) to:
Kathie Pendergrass 256-710-9806
127 Blackberry Trail
Florence, AL 35630 Postmarked by May 2nd
EMAIL: [email protected]
http://jeffdroporun4kids.org
Pre-Register by May 1st: 5K - $ 20 / 1Mile - $10
Day of Race:
5K - $ 25 / 1Mile - $15