Downloadable Entry Form

San Miguel Joint Union School District
Lillian Larsen School
1601 L Street San Miguel, CA 93451
(805) 467-3216 fax (805) 467-3410

Home of the HORNETS – “Pointing the Way to Excellence”

TWELFTH ANNUAL”BUZZ” MARATHON (USATF #CA04013RS)
At Camp Roberts
1/2 Marathon and 5K and Children under 12 1 mile RUNS
Saturday, February 18, 2012
Start Times
8:30 am Marathon & 1/2 Marathon (6:30 Walkers)
8:45 am 5K 9:30 am Kids 1 mile

FUND RAISER FOR THE ATHLETIC PROGRAMS
AT LILLIAN LARSEN SCHOOL
Serving Kindergarten to 8th grade students

RACE APPLICATION

Name _______________________________ Phone ___________________

Address ________________________________

City ___________________________ State ______ Zip/Country _________

e-mail ________________________________________________________________

Event Gender Age on race day _______
Marathon _____ Male ___
1/2 Marathon _____ Female ___

Cost: $40 by 2/1, $55 after “50 and DC” members: $30 by 2/1, $45 after
Active Military: $25 by 2/1, $40 after

5K ___ Cost: $20 by 2/1, $25 after

T-shirt size: Adult S  M  L  XL  XXL  Child S  M  L

Under 12 Children’s 1-Mile ___ Cost: $15 by 2/1, $20 after

Larsen Students: $10 by 2/1, $15 after _____

Race Day Registration begins at 6:15 AM
Please make checks payable to: Lillian Larsen School- Marathon

Please sign waiver: In consideration of the acceptance of my entry in the “Buzz” Marathon Run, I hereby waive, release and discharge any and all claims for damages, death, personal injury, disability, or property damages which may occur to me as a result of my participation in this event. This release is expressly intended to discharge in advance San Miguel Joint Union School District, Lillian Larsen School, State of California and Camp Roberts, their employees and sponsors. I agree to comply with all the rules and regulations and event instructions for the safety of me and other participants.

Signature _______________________________ Date _____________

Parent/Guardian waiver and release for minor
Signature of Parent/Guardian _______________________________ Date ___________

Name of minor _______________________________ Relationship to minor _______________