2010-05-04_PR Comm Packet - Laserfiche WebLink

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Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _______ _ City _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ State _ _Zip _ _ _ _ _ not legally required to disclose this information,failure to do so will prevent you/your child from participating.childÔs name,age,address,telephone number and health information will be provided to city staff,volunteers,the city manager,insTennessen Warning:The information requested on registration form will be used to verify eligibility and determine staff,faculty Signature _________________________________ Parent ofGuardian (ifunder 18)____________________________Each form must be signed.I have read and agree to the above waiver:verify that Ihave full knowledge ofthe event and that Iam physically fit and sufficiently trained to participate.a direct or indirect result ofmy participation in this event against the sponsors,coordinating groups,and any individuals assoc Waiver:ChampionChip® Number __ ____________ * T-Shirt Size:Youth Med __ Youth L __ Adult S __ Adult Med __ Adult L __ Adult XL__ Adult XXL__Event:5K Run 10K Run Wheelchair Fun Run Telephone Number (h) _ _ _-_ _ _-_ _ _ _ (w) _ _ _-_ _ _-_ _ _ _ Birth Date _ _/_ _/_ _ _ _Name (last name first) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Age _ _ Sex:M __ F __ Course Information - Run/Roll T-Shirt &Number Pickup - Run for the Roses features scenic 5K and Race numbers and T-shirt packets may be - Knowingly and at my own risk,I hereby apply to enter an athletic contest,and do hereby waive and release any and all claims for 10K race courses plus a half-mile Fun Run - picked up at Roseville Skating Center, - for children and families. Roll for the 2661 Civic Center Drive, on Friday, June - Roses features a 10K In-Line Skate Race 10K Roll Rec/Fitness 10K Roll Pro/Racer - 25, from 8 a.m. - 5:30 p.m. or at the check- - through the rolling hills of Roseville. in tables from 7 - 7:45 a.m. on race day. - - Runners are urged to pick up T-shirts on - Friday for best size selection. - Entry Fees - Early Registration (by June 21) - $18.00 - - After June 21 - $23.00 - Family Fun Run - $6.00 Categories - - Race Day Registration - Walkers must register for the 5K run only. - $25 Roll; - Racers are placed in the following cate- 2 $23 5K & 10K Runs gories for both males and females: 0 One Form Per Participant ¤ Please Print Fees include t-shirts and 1 • 14 and under• 15-19 0 are non-refundable. • 20-29• 30-39 R u • 40-49 • 50-59 n / • 60+• Wheelchair Early Registration for the Run R o To qualify for early registration, entry l IfParticipant has one,Roll for the Roses Participants only l The 10K Roll has the following categories forms must be received in Roseville Parks f o for both males and females: and Recreation Department, 2660 Civic r • Recreation/Fitness Center Drive, Roseville, MN 55113 by t h June 21. Online Registration Powered by e• Pro/Racer (5- & 4-wheel speed frames) Please make Roll registration check payable to: R Active.com or register at runningroom.com o or download a form at raceberryjam.com. s Please make Run registration check payable to: e Make run registration check payable to s Protective Gear E Run for the Roses. n Roll participants are required to wear a t r helmet and wrist guards. y Race Day Registration &Packet Pickup F o Race day registration and packet pickup r m Water Stops/Refreshments for Run and Roll participants are available - There will be water stops at selected loca- from 7 - 7:45 a.m. Run registration is in - the Rose Room (upper level of Roseville tions on the 5K and 10K courses. - iated with the event for said injuries.I - and equipment needs.Your/your Skating Center). Roll registration is in the Refreshments available at the finish. - urer and auditor.Although you are Fireside Room at Roseville Skating Center. - - Registration and check-in for the Fun Run R - damages that I may incur as o will be from 7 - 9 a.m. l l - f Start/Finish Locations o r- R t h - u Racers meet on the south side of Roseville e n R - f o o Skating Center on race day. Races start on s- r e s t h - e County Road C and Hamline Avenue. R - o Races finish on the Guidant John Rose - s e s - Minnesota OVALtrack. - -