First Name:

                  Address:

                        City:

                       State:

                           Zip:

                     Gender: Choose One Male Female

               Birth Date:

  Age On Event Day:

                       Phone:

                        Email:

                        Event:   Select One 1 Mile Run 1 Mile Walk 5K Run 5K Walk 10K Run Kids 1 Mile

                   Shirt Size: Choose One No Shirt Small Medium Large X Large XX Large

LIABILITY WAIVER:

Waiver: intending to be legally bound, I certify that my training and health are adequate for me to safely compete in the Rancho Tehama 1mi/5K/10K and hereby waive any claims for damages I may suffer due to participating in the events

  
                                          Waiver: Choose One Yes

                                      Signature:

Parent Or Guardian If Under 18:

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