2017 Rapides Junior Runners Registration Form
F
ill out form below (please print neatly) and include one-time, nonrefundable $45 fee.
Mail to:  Rapides Junior Runners     PO Box 4814      Pineville,LA 71361

If you do not preregister your child, race day registration is $60.  Please arrive early as
registration will end 15 minutes prior to the start of the race!

Replacement bibs will be $10 so please keep up with your original bib for all 4 races!!

Medals will be awarded to the top FIVE boys and top FIVE girls in each
1 mile age group.
Age groups -
1/2 mile - 5 and under
                           1 mile -  
6, 7,  8, 9,  10, 11
2 Mile race will be run as a Junior High Cross Country Meet
   Ages 12 - 14 as teams of 5 or individual
  Top 3 Males and Top 3 Females will receive meet t-shirts
If you would like to register a team, please contact us for more information.
rapidesjuniorrunners@yahoo.com
_______________________________________________________________________________

Name:_______________________________________________
Address:_____________________________________________
_____________________Zip:________Phone:______________
email:_______________________________________________

Age:__________Birthdate:___________________Sex:   M      F

Please circle T-shirt size:     YS        YM        YL        AS          AM        AL        AXL

Would you like an extra shirt?  Circle size and add $20 to total:  
YS      YM       YL       AS       AM       AL       AXL

I know that participating in a running event is a potentially hazardous activity.  I should not enter and participate unless I
am physically fit and properly trained, and by my signature, I certify that I am medically able to perform this event.  I
agree to abide by any decision of a race official relative to any aspect of my participation in this event including the right of
any official to deny or suspend my participation for any reason whatsoever.  I assume all risks associated with running in
this event, including but not limited to: falls, contact with other participants, effects of weather, including high heat and/or
humidity, traffic and the condition of the road, all such risks being known and appreciated to me.  I understand that
skateboards, scooters, rollerskates or roller blades, animals and radio headsets are not allowed in the running event and I
will abide by these guidelines.  Having read this waiver and knowing these facts and in the consideration of your acceptng
my entry, I for myself and anyone entitled to act on my behalf, waive and release Rapides Junior Runners, volunteers, and
any and all sponsors, their representatives and assessors from any claims or liabilities of any kind arising out of my
participation in his event, even though that liability may arise out of negligence or carelessness on the part of the person
named in this waiver.  I release the rights to any and all photographic material, including film and computer information.


Parent signature:_____________________________________Date:___________________