2009-06-09_PR Comm Packet - Laserfiche WebLink

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Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ auditor.Although you are not legally required to disclose this information,failure to do so will prevent you/your child from paYour/your childÔs name,age,address,telephone number and health information will be provided to city staff,volunteers,the city mTennessen 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:with the event for said injuries.Iverify that Ihave full knowledge ofthe event and that Iam physically fit and sufficiently trathat I may incur as a direct or indirect result ofmy participation in this event against the sponsors,coordinating groups,and a 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___ 10K Roll Rec/Fitness___ 10K Roll Pro/Racer ___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 - - picked up at Roseville Skating Center,2661 10K race courses plus a half-mile Fun Run 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 - Civic Center Drive,on Friday,June 26,from for children and families.Roll for the Roses - - 8 a.m.- 5:30 p.m.or at the check-in tables features a 10K In-Line Skate Race through - from 7 - 7:45 a.m.on race day.Runners are - the rolling hills ofRoseville. - urged to pick up T-shirts on Friday for best - size selection. - Entry Fees - Early Registration (by June 22)- $18.00 - - After June 22 - $23.00 - Categories - Family Fun Run - $6.00 - Race Day Registration - Walkers must register for the 5K run only. - - $25 Roll;$23 5K & 10K Runs Racers are placed in the following categories 2 0 for both males and females: One Form Per Participant ¤ Please PrintFees include t-shirts and are 0 9 ¤ 14 and under¤ 15-19 non-refundable. R ¤ 20-29¤ 30-39 _______ _ u ¤ 40-49 ¤ 50-59 n Early Registraion for the Run / ¤ 60+¤ Wheelchair R To qualify for early registration,entry forms o l must be received in Roseville Parks and IfParticipant has one,Roll for the Roses Participants only l f The 10K Roll has the following categories for Recreation Department,2660 Civic Center o both males and females: r Drive,Roseville,MN 55113 by June 22.Enter t City _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ State _ _Zip _ _ _ _ _ ¤ Recreation/Fitness h online for the run at www.active.com, e ¤ Pro/Racer (5- & 4-wheel speed frames) R runningroom.com or download a form at o s www.raceberryjam.com.Make check payable e s to Roseville Parks & Recreation. Protective Gear E n Roll participants are required to wear a t r Race Day Registration &Packet Pickup y helmet and wrist guards. F Race day registration and packet pickup for o r Run and Roll participants are available from m Water Stops/Refreshments 7 - 7:45 a.m.Run registration is in the Rose - There will be water stops at selected locations - Room (upper level ofRoseville Skating - on the 5K and 10K courses.Refreshments Center).Roll registration is in the Fireside - available at the finish. - Room at Roseville - - Skating Center. - ined to participate. - ny individuals associated Registration and rticipating. Start/Finish Locations and equipment needs. - check-in for the - anager,insurer and Racers meet on the south side ofthe - Fun Run will be - Roseville Skating Center on race day.Races - from 7 - 9 a.m. damages start on County Road C and Hamline - - Avenue.Races finish on the Guidant John - Rose Minnesota OVAL track. - -