ENTRY FORM AND RELEASE

2008 Run for Aaron

Saturday, April 19, 2008

All participants Must Complete and Sign this form.

Make checks payable to: Aaron Ploch Memorial Scholarship Fund

Send check & Entry Forms to:

Aaron Ploch Memorial Scholarship Fund

c/o Ryan Ploch

1368 Venezia Ave.

Vineland, NJ 08361

For more information please call: (856) 825-5228

**** Please fill out a separate form for each entrant registering ****

Name _____________________________________________

Street Address ______________________________________

City ____________________ State ____ Zip Code _________

E-Mail _____________________________

Phone _____________________________

Sex _____ Age (on 4/19)____ Shirt Size S__ M__ L__ XL__

5k Run _____ 1 Mile Fun Run/Walk ____

Relase and Wavier ( All Entrants must sign )

I, the undersigned acknowledge that a road race is a hazardous activity. I certify that I am medically able and have sufficiently trained for this event. I agree to abide by all decisions of the race as final. In consideration of the acceptance of my entry and intending to be legally bound, I do hereby for myself, and anyone entitled to act on my behalf, waive, release, and discharge The Aaron Ploch Memorial Swimming & Soccer Scholarship Fund, it's officers, the Borough of Vineland, St. Padre Pio Parish, L&M Timing Sports, and any and all sponsors and their agents, employees, representatives, successors, and assigns for any and all injuries suffered by me in said event.

_____________________________________________________________ ____________

Signature (parent if under 18) Date