(must be postmarked by Thursday, November 8th)
7:15am - Registration opens
9:00am - 3k Run/Walk start
9:00am - 10k Run start
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APPLICATION
5th Annual Dublin Trot for Tots
Trot For Tots
3 K
RUN/WALK 10K RUNNERS ONLY
Sunday, 11 November 2007, 9:00am, Dublin Coffman High
School, Dublin, Ohio 43017
ENTRY FEE
Before November 5th , $20.00,
after November 5th through race day, $25.00
Packet pick up (race bib, T-shirt, raffle ticket, sponsor info, etc.) starts at
7:15am
Coffman High School, 6780 Coffman Rd, Dublin, Ohio 43017
Early Packet pick up available at the CRC beginning November 5th.
Make check
payable to C.R.C. Charity Fund and mail to:
6465 Perimeter Drive, Dublin, Ohio 43016
Email: ______________________________________________________
Name: _________________________________________ Age: _____ Sex: M / F
*GROUP LEADER Y/N (GROUPS = 3 to 15 runners) We must have a form for each entrant in the group.
*GROUP NAME _______________________________________ Number of runners in group ____
*($15.00 per runner in the group, max 15 runners per group name)
Address: ____________________________________________________________
City: ______________________ State: _____ Zip: _________ Phone: _________________
T-shirt: S M L X XX CIRCLE ONE: 3 K RUN/WALK 10K RUNNERS ONLY
T-3 Trot for Tots 2007 Event Waiver and Release: I agree that by participating in this physical activity, program or event (the "Event"), by using any Event facility or Event premises, I do so at my own risk. I agree I am voluntarily participating in the Event and using Event facilities or premises and assume all risk of injury, illness, damage or loss to me or my property that might result, including without limitation, any loss or theft of personal property. I hereby consent to medical treatment in the event of injury, accident and/or illness during the Event. I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) to release and discharge Columbus Running Company, and all Event sponsors from any and all claims or causes of action (known or unknown) arising out of their negligence. I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a release of liability. By my signature below, I am waiving any right that I (my personal representatives, heirs, executors, administrators, agents and assigns) may have to bring legal action to assert a claim against Columbus Running Company, and all Event sponsors for their negligence.
signed_________________________________________________________________________ date _________________________
Parent or Guardian if under 18: signed____________________________________________________________ date ________________
www.ColumbusRunning.com/t3.htm Trot 4 Tots main page.