Kiwanis Club of Bastrop 5K Toad Trot - Registration Form
Make checks payable to:	The Kiwanis Club of Bastrop
Print this form, fill it out and send to:	Terri French c/o First National Bank P.O. Drawer F Bastrop, TX 78602

Name Address City, State, Zip Day Phone Evening Phone Email Address Age on 10/3/2009 Sex Select Age Division    ___  14 & below    ___  15-19    ___  20-24    ___  25-29    ___  30-34    ___  35-39    ___  40-44    ___  45-49    ___  50-54    ___  55-59    ___  60-64    ___  65-69    ___  70 & over   Circle Shirt Size    Short Sleeve T-Shirt:    Small      Medium      Large      X Large      Waiver: WARNING! Participation in the Kiwanis Club of Bastrop 5K Toad Trot can be a serious threat to the health of individuals who are not in excellent physical condition and health. I fully understand that my participation in the Kiwanis Club of Bastrop 5K Toad Trot may result in serious illness or death. Although I fully appreciate those risks, I desire to participate without regard to the consequences. I waive all claims I might have against Kiwanis Club of Bastrop 5K Toad Trot, RunTex, or any other individual, firm, or organization resulting in whole or part from my participation in the Kiwanis Club of Bastrop 5K Toad Trot. This waiver shall be binding on my heirs, legatees, administrators and assigns. Further, I hereby grant full permission to any of the foregoing to any photographs, videotapes, motion pictures, or recordings of this event for any legitimate purpose.   Participant's signature Date   Guardian's signature, if participant is under 18 Date

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