5K Run/Walk, 1 Mile Fun Walk

Saturday, December 7, 2013

Sponsored by Grayson County 4-H

Leitchfield City Park

(Race begins at Pavilion)

Registration/Check-in: Race Begins:

7:15-7:50 a.m. CST 8 a.m. CST

Awards will be given for Overall Male & Female and Top finishers in each age group.

Please complete the following information and return to the Grayson County 4-H Office by

December 6 no later than 4:00 or return at registration table on morning of 7th.

Name: _______________________ Address: __________________________________

City: ________________________ State: __________ Zip Code: _______________

Phone: _______________________ E-mail: _____________________________

Gender: M F (circle one) Age on race day: ______

T-shirt size (adult sizes): S M L XL (circle one)

Race (choose one): 5K 1 Mile Fun Walk

Entry Fee: $20 pre-registration or $25 day of; $15 for 1-mile fun walk

Waiver of Liability:

In consideration of the acceptance of my entry, I hereby for myself, my

heirs, executors and administrators do release any and all sponsors and associates of the Grayson

County Cooperative Extension Office and the Hometown Christmas Run of any damages,

demands or actions whatsoever in any manner arising or growing out of my participation in this

run. I attest and verify I have full knowledge of the risk involved in this event and that I am

physically fit and sufficiently trained to participate in it.

Signature: ___________________________________ Date: __________________

Signature of Parent, if under 18 years of age: __________________________________

Please send checks to:

Grayson County 4-H Council

123 Commerce Dr.

Leitchfield, KY 42754

Questions: 270-259-3492 (ask for Kindra)