Fill out form below (please print) and include one-time nonrefundable $25 fee.
Mail to: Rapides Junior Runners
PO Box 4814
Pineville,LA 71361
Race day registration is $35 and will end 15 minutes prior to the start of the race!
Name:______________________________________________
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Address:____________________________________________
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_____________________Zip:________Phone:_____________
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email:______________________________________________
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age:_______Birthdate:___________________Sex: M F
School:_________________________________________________________
*T-shirt size: YS(4-6) YM(8-10) YL(12-14) Adult S M L XL
___Check and circle size if ordering an additional shirt. Cost for extra shirt-$15.
Remember...You must run with your age group to be eligible for a place medal!
I know that participating in a running event is a potentially hazardous activity. I should not
enter and participate unless I am physically fit and properly trained, and by my signature, I
certify that I am medically able to perform this event. I agree to abide by any decision of a
race official relative to any aspect of my participation in this event including the right of any
official to deny or suspend my participation for any reason whatsoever. I assume all risks
associated with running in this event, including but not limited to: falls, contact with other
participants, effects of weather, including high heat and/or humidity, traffic and the condition
of the road, all such risks being known and appreciated to me. I understand that
skateboards, scooters, rollerskates or roller blades, animals and radio headsets are not
allowed in the running event and I will abide by these guidelines. Having read this waiver
and knowing these facts and in the consideration of your acceptng my entry, I for myself and
anyone entitled to act on my behalf, waive and release Rapides Junior Runners, volunteers,
and any and all sponsors, their representatives and assessors from any claims or liabilities of
any kind arising out of my participation in his event, even though that liability may arise out
of negligence or carelessness on the part of the person named in this waiver. I release the
rights to any and all photographic material, including film and computer information.
Parent signature:_______________________Date:_________