Starlight Children's Foundation's 5K Run and 10K In-Line Skate
 Saturday, September 12, 8:00 am
     First Name: 
      Last Name: 
        Address: 
           City: 
          State:       Zip: 
          Phone: 
         E-Mail: 
   Today's Date: 
  Date of Birth:    Age: 
     Shirt Size: M L XL
         Gender: M F
WAIVER/RELEASE:

I know that running or in-line skating a road race is a potentially hazardous activity. I should not enter and participate unless I am medically able and properly trained. I assume all risks associated with competing in this event including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Starlight Children's Foundation, the city of Alexandria, and all sponsors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the person named in this waiver. 

_______________________________  _____________ _________________________________
Signature                        Date          Parent's Signature if under 18
Work Phone:
Employer:
Please place a check mark next to the appropriate statements:
My employer has a matching gift program and rewards volunteerism.
I would be willing to collect donations in the name of Starlight.
I plan on bringing my children to play in the children's play area.
I am a wheelchair athlete.
Event(s) in which I will participate:
5K Run
10K Fun Roll
10K In-Line Race
Barbecue
You may sign up for as many events as you like and pay only one entrance fee.Only qualified individuals may enter the In-Line race.

Your completed form and payment for $20 ($15 for child under 15) (or $25 after 9/5) may be mailed to Starlight Races, 4301 N. Fairfax Drive, Suite 1119, Arlington, VA 22203.

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