CSCS Lions Pride 5K FunRun/Walk May 14, 2011 * 9 am * Monument Valley Park

1. CSCS Lions Pride 5K FunRun/Walk May 14, 2011 * 9 am * Monument Valley Park Family Registration: $75 for a family of 3 or more if received by April 29, 2011. Receive 4 t-shirts. Additional t-shirts may be purchased for $8 each. Fill out entire form. Individual Registration: $25 if received by April 29, 2011. Receive one t-shirt. Fill out the middle portion of this form only. Last Name First Name Address City State Zip Daytime Phone (xxx-xxx-xxxx) Alternate Phone (xxx-xxx-xxxx) Date of Birth (mm/dd/yy) Age (on race day) I hereby release the city of Colorado Springs, Colorado Springs Christian School, So CO Runners and all Municipal agencies whose property and/or personnel are used, and other sponsoring individuals and/or companies from responsibility for any injuries or damages I may suffer as a result of my participation in the CSCS Lions 5K FunRun/Walk and related events. I hereby certify that I am in good physical and mental condition and am able to safely compete in this event. I hereby consent to receive emergency medical treatment at my own expense, which may be deemed necessary in the event of injury, accident or illness during this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspapers, brochures, etc. I understand that my entry fee is nonrefundable and I agree to abide by the rules of this race. As a participating athlete, I certify all information provided in this form to be accurate and complete. I have read the entry information provided for this event and certify my compliance with my signature on this form. If I do not follow the rules of this event, I understand I may be removed from the event. I give full permission to CSCS and its local affiliates and their sponsors and corporate sponsors to use my photographs, videotapes or other recordings of me that are made during the course of this event. Signature: ______________________________ To register for the 2010 Lions Pride 5K FunRun/Walk, fill out the entry form below and return with a check payable to CSCS (5K on the memo) and mail to: CSCS Elementary School Attn: Lions Pride 5K FunRun 4845 Mallow Rd Colorado Springs, CO 80907 Mail in the bottom portion of this form and save the top portion as a reminder. Payment must be received with registration form in order to be processed. For information about this event prior to race day, contact Cristina Wright at CSCS5K@gmail.com or call CSCS at 535-8965. REGISTRATION FORM MUST BE FILLED OUT COMPLETELY. Choose T-shirt Size ____ YS ____ YM ____ YL Registration deadline: Registrations received after April 29 will incur a late fee of $10/individual; $15/family and T-shirts will not be guaranteed. No race day registration. ____ AS ____ AM ____ AL ____ AXL ____ AXXL How did you hear about this event? For family registration only: Name 2 _______________________ Age _______ T-shirt (Included) Size _________ Name 3 _______________________ Age _______ T-shirt (Included) Size _________ Name 4 _______________________ Age _______ T-shirt (Included) Size _________ Name 5 _______________________ Age _______ Add T-shirt ($8 ) Size _________ Name 6 _______________________ Age _______ Add T-shirt ($8 ) Size _________ Total amount due: $25 for individuals; $75 for families/4 or more + $8/each additional shirt. Make checks payable to CSCS with 5K on the memo.