GUAMS LARGEST 5K AND COMMUNITY FAIR!

KICK THE FAT 5K

Paseo Stadium, Hagatna

Show Time: 5am | Go Time: 6am
Proceeds to benefit Sanctuary Incorporated, Guma Mami and Ericas House of Hope through the Pay-Less Community Foundation.

MARCH 15, 2014 ~

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Early Entry Fees: $7/person | $25/Family of 4 (2 adults max.) Race Day Entry Fees: $10 /person

Runner (Name): Mailing Address: Age on Race Day: School: Division: Youth (13 and under) Master (40-49) Junior (14-19) Senior (50-59) Open (20-29) GrandMaster (60-69) SubMaster (30-39) Manamko (70+) D.O.B.: Telephone #: Male Female

Please note: A child in a stroller will not receive an official finisher time due to the large volume of runners participating. Release form - MANDATORY In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release all claims and damages I have against Pay-Less Markets, Inc. Pay-Less Community Foundation, and the Guam Running Club, all sponsors, and their representatives and any and all claims of damages, demands, actions whatsoever in any manner as a result of my participation in said event; including but not limited to any injuries I might suffer. I acknowledge that I am aware of the inherent risks in participation in an athletic event of this type. I attest and verify that I am physically fit and have sufficiently trained for completion of this event and my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use my name, my voice and or my picture in broadcast, telecast, advertising, promotion or other account of this event for any purpose whatsoever. I understand that the entry fee is non-refundable and numbers are non-transferable. If I am making this application on behalf of my son/daughter, or minor for whom I am legal guardian, as set forth above with regard to their and/or my knowledge of risks, physical fitness, and training, and use of image. I hereby attest and verify that my son/daughter or minor for whom I am legal guardian on whose behalf I make this application, has my permission to run in the Kick the Fat 5K Run on March 15, 2014. I understand the use of bicycles, roller blades, skateboards and ear/headphones are not permitted.

Signature:

Date:

Parent/Guardian:

Checks should be made out to Pay-Less Markets Community Foundation

Saturday, March 15, 2014 Paseo Stadium, Hagta Show Time: 5am | Go Time: 6am
Name: Cash Check

M OD CO URIFIE SE D
KTF 2014 COMMUNITY FAIR

RECEIPT - ENTRY FEE

Verified By:
Finisher cards

Date: