Brenner Children's Classic Run
Registration Form

Fill out and print this form; then mail it with your check (check payable to: BCCRUN) to:
Brenner Children's Classic Run
c/o Joyce Williams
3945 Yarbrough Ave.
Winston-Salem, NC 27106
Name

First
Middle
Last		     Sex:   M   F
Address
City State/Province   Zip
Phone ( )    Age    Date of Birth //
E-mail
Shirt Size S     M     L     XL     XXL (Add $2 for XXL)
5K
Run		 $16 before 9/2/2008
$20 before 9/6/2008
$25 Race Day
1-Mile
Fun Run		 $10 before 9/6/2008
$15 Race Day
School Challenge Sponsor Only    (Min. $10 Donation)
Donation for Brenner Children's Hospital     Total
Total Amount Enclosed (Tax Deductible)
I support School for the School Challenge.

Official Rules:    For Official Rules, call race directory Jerry McDonald at (972) 792-3345 or email at director@bccrun.org.

Waiver:
I hereby attest that I am physically fit and have sufficiently trained for participation in this event. I assume all risks associated with running this race -- including, but not limited to falls, contact with other participants, the effects of the weather, traffic, and the conditions of the road -- all such risks being known and acknowledged by me. In consideration of your accepting my entry, I, the undersigned, waive and release Brenner Children's Classic Run, race officials and all race sponsors related to my participation in this race. Further, I give permission for the free and unrestricted use of my name and picture as a participant in the race for any legitimate purpose.

Per Winston-Salem Police Department, absolutely no baby joggers, strollers, or dogs on leashes allowed on 5K course. After 45 minutes the 5K course will be closed and runners will be asked to move to sidewalks.

Signature ____________________________________ Date __________
If under 18 ____________________________________
Parent/Legal Guardian Signature