Here’s Looking at You Kid 5k and Kids Run Entry forms 
     Please complete an entry form for each individual entrant!       

Last Name_________________________ First Name____________________                

Address__________________________________________________________ 
                                                 
City_______________________  State_____   Zip _____________

Home Phone(____) ____ ______       Email_______________________________

Circle One:      Male         Female       Age on race day_____

Group Name*_______________________________

Circle One:      5k      or   Kid’ Run, circle one:   Kindergarten & U - 50 meters
                                                                          1^st & 2^nd Grade - 200 meters
                                                                          3^rd & 4^th Grade - 400 meters
                                                                          5^th & 6th Grade - 800 meters   

Shirt Size (5k participants only):   S        M         L        XL        XXL                          

Make check payable to: Dublin City Schools (Memo: CGF)
Mail entry to: Coffman Teen Institute, 6780 Coffman Rd.  Dublin, OH 43017

Entry Fees
5k:  Pre-registration (by 4/13)  $20.00    Week of and race day: $25.00
*Group (4 or more) discount (by 4/13)  $15.00ea.
Kid’s Race-  Free- simply turn in a waiver.  

Waiver:   In consideration of the acceptance of this entry, I hereby waive and release any and all right and claims for damages that I or my heirs may have against Dublin Schools, the Teen Institutes, Columbus Running Company, City of Dublin, race sponsors and volunteers. I certify that I have properly trained for this event and am medically able to participate.                                               

Signature______________________________________________  Date____________

Guardian Signature (If under 18)___________________________  Date____________