Print this form, complete it and mail to the address below.

Registration Form

Pleasant Hill Student   yes___  no ___  If yes, teacher name:_______________

Address:________________________  Phone:_______________________

T-shirt size:(circle one) YL   Adult:   S   M     L    XL

Fees:

5K........$15.00 by May 1st/$20.00 after May 1st ......................$_____________

1Mile(Fun Run) $15.00 by April 26th/20.00 after May 1st........$_____________

                                                                                    Total ......$____________

Make Checks Payable To: got hope? Run for Research                                              

Mail entry forms to: got hope?Run for Research

                                Pleasant Hill Elementary

                                1N220 Pleasant Hill Road                              

                                 Winfield, Il 60190

Please sign waiver below.   We cannot accept unsigned entries.

I know that running a road race is potentially hazardous activity.  I should not enter unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the course.  I assume all risks associated with running in this event including but not limited to:falls, contact with other participants, the effects of weather, traffic and conditions of the road, all risks known and appreciated by me.  Having read this waiver and knowing these facts and in consideration of acceptance of entry, I for myself, and anyone entitled to act on my behalf, waive and release CUSD 200, the cities of Wheaton, Winfield and Warrenville, the American Brain Tumor Association and all sponsors and individuals associated with this event, their representatives and successors, from all claims and liabilities of any kind arising out of my participation in this event even though that liability may arise out of carelessness or negligence on the part of the persons named in this waiver.  I grant Pleasant Hill Elementary, and its authorized agents to use my name, photograph, video taped, motion picture recordings, or any other records of my participation in this event for legitimate purposes.

Runners Signature _________________________________________  Date _________________

If under 18, Parent's Signature _______________________________ Date _________________