CASA Glow Run

Race Registration

CASA Superhero Glow 5K Run/Walk & Family Event

Saturday, June 14, 2014 at 6:00pm

Race will start around 8:15pm (around sunset)

Old Community House at Lions Park

All proceeds go to CASA of Laramie County

For more information about the event or registration: visit www.casalc.org, or call the CASA office at (307) 222-1902,

or email either Felicia Raimondi at fsprai79@yahoo.com or Carol Tullio at ctullio@casalc.org

Name:  Last                                                                                             First                                                             MI       .

Birth Date:              /             /                            Age:                                                                                Gender:  M   F

Address:                                                                                                                                                                                        

City:                                                                        State:                      Zip Code:                                                                

Phone:  (            )                                              Email:                                                                                                           

Emergency Contact Name:                                                            Phone:  (          )                                                   

Adult T-shirt size (please circle one)       S          M         L          XL        2XL         Child    (check if for child)

Please note that we will try to give you the size requested, but we cannot guarantee it.

                  Single Registration $30              Running          Walking

                                Event packet will include 1 adult T-shirt and 5 glow sticks

                  Family Registration $60  Please fill out and attach one entry form for each family member.       

                                Event packet will include 2 adult T-shirts, 2 capes, and 10 glow sticks

                                I would also like to make an additional donation of   $                                 

Please mail check and entry form(s) to:

CASA of Laramie County

3001 Henderson Dr. Suite E

Cheyenne, WY 82001

Make checks payable to: CASA of Laramie County

WAIVER   (please read before signing)

I know that my participation in this event is a potentially hazardous activity. I will not enter and participate unless I am medically able and properly trained. I agree to abide by any decision of any race official as to my ability to safely complete the event. I assume all risks associated with this event, including but not limited to: falls, contact with other participants, effects of weather including high heat and humidity, traffic, and the condition of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in the consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release CASA of Laramie County, race officials, volunteers, and all sponsors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purposes.  NO REFUNDS.

 

Signature of Superhero: (participant)                                                                               Date:                          

Parent Signature (if under 18 years of age)                                                                                  Date:                           

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Kevin Schei,
May 14, 2014, 12:05 PM
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