RACE: check one or both --   1 mile _____ (all age groups)     5K ______ (10 & older)     

NAME: __________________________________________________________

ADDRESS: ________________________________________________________

CITY: ________________________________________ STATE: _____ ZIP: __________

YOUR AGE: ______________ GENDER: M   or   F

T-Shirt size: ( circle one )    Youth Small (6-8) Youth Medium (10-12) Youth Large (14-16)    

                                              Adult Sm        Med    Large     X-Large

Parent Signature: ___________________________________________________

                             (if under 18 years of age)

Upper Deerfield Students ONLY

Homeroom number ______ / Grade ____      H.R. Teacher __________________________

____ I do not wish to run but would like to buy a t-shirt $5.00 each. Size: _____

Make checks payable to : Upper Deerfield Schools

Mail to:

Woodruff  School

C/O Dawn Magee

1373 State Highway 77

Seabrook, NJ 08302