ENTRY FORM AND RELEASE

LAUREL SPRINGS

Saturday, May 10, 2008

All participants Must Complete and sign this form.

Make checks payable to: Laurel Springs Recreation Commission

Send check & Entry Forms to:

Laurel Springs Borough Hall
Attention: Barbara Hawk
135 Broadway
Laurel Springs, NJ 08021

For more information please contact: Barbara Hawk at (856) 784-1551

First Name _____________________________________________

Last Name ______________________________________________

Street Address __________________________________________

City _______________________________ State ____ Zip Code _________

Phone ______________________________

Age ______ Sex ____ Shirt Size M __ L __ XL ___

5K Run _____ 1 Mile Fun Walk ____

Race fee: $ ___________

Donation to help the Laurel Springs Fire Department $ ________

Relase and Wavier ( All Entrants must sign )

In consideration of your accepting this entry, the above signed entrant, intending to be legally bound for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages that I may have against The National Foundation for Osteoporosis, the Borough of Laurel Springs, Laurel Springs School, L&M Timing Systems, and any and all sponsors and their agents, employees, representatives, successors, and assigns for any and all injuries suffered by me in said event and my physical condition has been verified by a licensed physician.

_______________________________________________________________ ____________

Signature (parent if under 18) Date