Halloween Horror Fun Run
October 30, 2009
Please fill this out completely! Yes, we NEED this information.
Name: _____________________________________________________________________
Address:____________________________________________________________________
City: ________________________________ State: ___________ Zip: _________________
Email address: _______________________________________ Phone: ________________
Birth date: ___________________________ (including year please!) Gender: M F
Shirt size (please circle) adult XL L M S youth XL L M S
Race you would like to enter (please circle) 5K .5mile
Fees: $23, day of race $25
$95, day of race $110
Please make checks payable to One For Fitness
Amount paid: _____________
Note: Families wanting to use the family rate must be immediate family living at the same address up to 6 people. They may register for any combination of races, but must register all at the same time. The Family rate is not available for online and must be mailed in.
Waiver & Liability Release
I, the undersigned, hereby state that I am physically fit enough to complete the Halloween Horror Fun Run. I understand that there are inherent dangers and risks associated with such activities and that I will in no way hold the directors of the race, South Jordan City, the Healthy South Jordan Coalition any of the race sponsors, race personnel or volunteers liable for any injury or death incurred as a result of participating in this event. I, nor my family or survivors will hold the above stated liable or request any compensation or retribution for any losses incurred by my participation in this event. I understand that the purpose of this event is for entertainment and recreation purposes only.
___________________________________________________________________________ __________________
signature of participant or of guardian if participant is under age 18 Date
Mail this form with check made payable to One For Fitness to
9594 S Tarbert Cir South Jordan UT 84095
Online registration available at www.healthysouthjordan.org
Questions contact Kelly @ 801-634-5490 or Kelly@oneforfitness.com