stampede registration form

REGISTRATION FORM

2007 racelab KIDS

SPRING RACE SERIES

Fill out one form for all your sons and daughters that will participate in

the race or races... PLEASE CALL US (480) 502 9975 IF YOU HAVE ANY

QUESTIONS ABOUT THE EVENTS OR ABOUT REGISTRATION...

Last Name:___________________________

First Name(s): _______________ DOB_________ Age______ Sex M / F Race 2K 800m 100m

_______________ DOB_________ Age______ Sex M / F Race 2K 800m 100m

Address:_____________________________

City:_______________________ State:____ ZIP:________

Tel.:________________ email Address_________________________________

	ONE Kid	Family Fee TWO or more Siblings	My child(ren) will participate in:
			2K	800m	100m
			write the number of kids participating in each race
Stampede at the Zoo	$30	$50 / family

I am enclosing a check for a total of $________

Write check to racelab.

WAIVER (MANDATORY): All applications MUST be signed by the participant’s Parent or Legal Guardian. In consideration of

accepting this entry or entries, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and

administrators, waive and release any and all rights and claims for damages I or my spouse may have against the,

RACELAB LLC, RED ROCK CO., OR THE PHOENIX ZOO or anyone associated with this event, their representatives,

successors and assigns for any and all injuries suffered by MY CHILD(REN) in ANY of the events marked above.

I will additionally permit the free use of my child(ren)’s name(s) and pictures in broadcasts, telecasts, newspapers, etc.

Invalid unless signed by:

_______________________________ ______________

Parent or Legal Guardian Date

MAIL REGISTRATION AND CHECK TO:

racelab; 10591 E. Palomino Rd.; Scottsdale, AZ 85258