Pulaski Area Swim Club
Polka Trot 5K Run / Walk
2010
Date:
Saturday, July 24th, 2010
Time:
8:30 a.m. 5K run / walk
9:30 kid’s run (ages 4 – 9)
Checks payable to: Mail
Registrationn Forms to:
PASC PASC Polka Trot 5K
$15 (postmarked by 7/14) P.O. Box 486
$25 (postmarked after 7/14) Pulaski
WI 54162
1/4 mile
kid’s run (free for kids registered for 5K)
Place:
Pulaski Middle School
911 S.
St. Augustine
Pulaski, WI
54162
(north on Hwy. 32 to stoplight, left on Crest
Drive to St. Augustine)
Registration:
5-7 p.m. Friday night
packet pick-up at Pulaski Middle School
7 – 8 a.m. (packet pick up and late registration Proceds
to Benefit the Pulaski Area Swim Club
Awards:
age groups (10 &
under); (11-14); (15-19); (20-29); (30-39); (40-49);
(50-59);
(60-69); (70 & over)
t-shirts
for all participants and drawings for door prizes
medals
for all kid’s run participants- No
T-shirts for kids participants
Enjoy:
Pulaski Polka Days events
including: craft fair, polka days grounds, fireman
water
fights
Visit:
www.pulaskipolkadays.com or swimpasc.org . email swimpasc@hotmail.com
Last Name ___________________________________________
First_____________________________________ MI_______
Address____________________________________________________________
City________________________________________
State _____ Zip __________ Phone (____)___________________________ email
_____________________________________
5 K run ______ male_____ age on race day
_______
walk______ female_____ date of birth
___/___/____
Adult t-shirt (circle size) small med. large x-large xx-large
Kid’s Run _______ age on race
day _______
In
consideration of acceptance of this entry in the Polka Trot 5K, I hereby freely
agree, for myself, my heirs, executors
and administrators, to waive, release and discharge all rights and claims which
I may have against the sponsors of the event, organizer and promoter, the land
owners, any and all contributors and any and all workers, whether paid or
voluntary, for any and all damages which may be sustained by me or my family,
directly or indirectly in connection with my participation in, or travel to or
from the event. I agree to personally inspect all the race facilities and will
refuse to participate if I am not satisfied with the safety thereof. WI STAT
895.525(3)(4) *”a participant in recreational activities…accepts the risk
inherent in the recreational activity
of which the ordinary prudent person is or should be aware.”
If participant is under
age 18, parent or guardian must sign
Signature of participant Date
________________________________________________________________ ________________
Signature of parent or legal guardian if
minor Date
________________________________________________________________ ________________