ENTRY FORM AND RELEASE

Katz JCC 5k

Sunday, October 26, 2008

One Mile Walk/Run - 8:15 am | 5k Run - 9:00 am

All participants Must Complete and sign this form.

Make checks payable to: Katz JCC

Send check & Entry Forms to:

Katz JCC
c/o Gene Bonetti
1301 Springdale Rd.
Cherry Hill, NJ 08003

For more information please contact: Gene Bonetti at 856-424-4444 ext. 141

Last Name _____________________________

First Name ____________________________________

Street Address __________________________________________

City _______________________________ State ____ Zip Code _________

Phone ______________________________

Email ______________________________

Age ______ Sex ____  Shirt Size Adult: M__: L__: XL__ Child: Med ___: Lg ___

__ $10 Kids Mile Walk/Fun Run __ $15 5K Pre-Registration

Emergency Contact and Phone Number ________________________________________________

Relase and Wavier ( All Entrants must sign )

In consideration of this entry being accepted, I hereby for myself, heirs, executors and administrators, waive and release any claim I may have against the Betty & Milton Katz JCC, the Township of Cherry Hill, its officers and directors, the organizing committee, the sponsoring organizations, the County of Camden or their representatives, successors, or assignees for any injury that may be suffered by me at this event.

_______________________________________________________________  Parent/Guardian Signature ____________Date