Name: 

      Address: 

         City: 

        State:    Zip: 

        Email: 

    Club Name:   Club Number: 

Daytime Phone:  Date of Birth:  Age on race date: 

       Gender: M F

        Event: 10K (6.2 miles)5K (3.1 miles)Family Fun Run

 T-shirt Size: S  M  LG  XL  Youth M  Youth L

 Pre-registration fee  (before April 21st):  Fun Run - $15 per person,
  5K - $25 per person, 10K - $30 per person 
 Late registration fee  (after April 21st):    Fun Run - $15 per person,
  5K - $30 per person, 10K - $35 per person   

Waiver Must Be Read and Signed Before Mailing:
I know that running is a potentially hazardous activity. I should not enter or run this event 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 risks associated with running in this race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, 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 acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the Town of Westford, the Westford Charitable Foundations, Inc., all sponsors, their representatives and successors from all claims of liabilities of any kind, including any claims arising out of negligence of the aforementioned parties, arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recording, or any other record of this event for any legitimate purpose.

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Signature                        Date          Parent's Signature if under 18