Sarah Housholder- Horn 8:18pm Feb 23
 Cost is

$10.00 Kids ages 7 to 12 with shirt, (6 and under free-no shirt) 
$25.00 Registration BEFORE May 18th (includes T-shirt) age 13 and up 
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Friends of Lake Wapello State Park
   

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Shore to Shore

 June 14, 2014

Register online or by mail.

Download the registration form and mail to:
Friends of Lake Wapello
P.O. Box 214
Bloomfield, IA  52537

Complete the form below to register online.
 One entry per form.
Shore to Shore Early Registration
June 14, 2014 7:30 a.m. signup
(* Required Fields)

$10.00 Ages 7 - 12 with shirt (6 & Under free - no shirt)
$25.00 Registration before May 18th Ages 13 & up (shirt included)
$30.00 Registration fee after May 18th

First Name: * *
Last Name *
 Age: *  
Address Street 1: * *
Address Street 2:
City: * *
Zip Code: * (5 digits)*
State: *
Daytime Phone: * *
Evening Phone:
Email: * *
   Sizes available:  Youth Sizes: S M L *
                             Adult Sizes:  S M L XL XXL *
Adult Sizes
Youth Sizes:
Waiver: *
Parent/Guardian/Athlete Consent
The above named participant and the participant’s parent/guardian have requested registration of the participant in the Lake Wapello Shore to Shore Fun Run.  In consideration of such registration, the right of the participant to compete in the event and the use by the participant of the sponsoring agency’s facilities and equipment, both participant and the parent/guardian each acknowledge that the participant will be competing in the Lake Wapello Shore to Shore Fun Run and using sponsoring agency’s facilities at the participant’s sole risk and both the participant and the parent/guardian each agree to waive, release, absolve, indemnify and to hold harmless the Friends Group of Lake Wapello, the State of Iowa, the organizers, coaches, sponsors, supervisors, officials and other participants from any claims arising out of an injury.  We also agree to allow the Friends of Lake Wapello to use and reproduce the participant’s name and/or likeness and/or information concerning the participant and to circulate the same for any and all purposes in any manner.  I know that running a race is a potentially hazardous activity.  I should not enter and run unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the run.  I assume all risk associated with the running in this event including, but not limited to falls, contact with other participants, the effects of the weather and temperature, traffic and the conditions of the course, all such risk being known and appreciated by me.  I/We certify that the information on this participation form is correct.
 
(Signature of Parent/Guardian/Athlete)  *                                          
 *
Comments:



$25.00 Registration BEFORE May 18th (includes T-shirt) age 13 and up 
$30.00 Registration AFTER May 18th age 13 and up. 
Click here to 
 with PayPal

$10.00 Kids ages 7 to 12 with shirt, (6 and under free-no shirt) 
 Click here to 
 with PayPal