Print this page and mail in.
CVS Caremark Downtown 5k Race Registration Form
Age on race day |__|__| Male Female |__| Police |__| Firefighter |__|
Project 5K time (3.1 miles) Minutes ___________ Seconds_______________
If no time entered you will start in last wave start.
Check here if walking |___|
First Name |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| MI |___|
Last Name |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Address 1 |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Address 2 |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
City |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
State |___|___| ZIP |___|___|___|___|___|
Phone –– (In case we need to reach you for problems with your entry)
|___|___|___|-|___|___|___|-|___|___|___|___|
IF YOUTH RACE YOU MUST CIRCLE GRADE/RACE THAT PARTICIPANT WILL BE IN ON RACE DAY.
5K Run/Walk |__| Youth Race GRADE |___| Wheelchair |__|
Grade (CHECK correct grade/race)
Age 1 to 3 |___|
Kindergarden |___|
1st Grade |___|
2nd Grade |___|
3rd Grade |___|
4th Grade |___|
5th Grade |___|
6th Grade |___|
7th Grade |___|
8th Grade |___|
All Kids Can |___|
E-mail address
______________________________________
Corporate Team Name____________________________________
Corporate teams members must submit all team entries together with corporate Team Declaration Form.
(See corporate team section for how to get team entry forms. Can be printed of this site)
USA T&F Club Number (Required for USATF members only) ______Club Name_____________________________
USATF club members must submit all team entries together with USATF team declaration form to be scored as a team. Team forms can be printed from this site.
DO NOT MAIL AFTER 9/13/2008 See registration for entry fee
Make checks payable to: Downtown 5k, Inc.
Mail to: Downtown 5k, Inc.
P.O. Box 1940
East Greenwich, RI 02818-0663
START TIMES:
Women's and Men's Race starts 11:15 a.m.
Youth Races start 8:00 a.m.
Waiver: In consideration of the acceptance of this entry. I hereby for myself, heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against CVS Caremark and its respective, parents, subsidiaries, affiliates, successors and assigns, Downtown 5K, Inc., the City of Providence, USATF, sponsors, race officials, organizers and volunteers associates with this event for any injury that may occur as a result of my participation in this event.
Further, I agree that any pictures or photographs taken of me by CVS Caremark or Downtown 5K, Inc., or their respective agents, in connection with this event are owned by CVS Caremark and Downtown 5K, Inc., and I waive all rights to inspect or approve the final product. I hereby irrevocably grant to CVS Caremark and Downtown 5K, Inc. or their respective assigns, the right and permission to use or license the use my name, likeness, voice, image or photograph of me, gathered in connection with this event, in any media or manner for the purpose of promotion of CVS Caremark and Downtown 5K, Inc., and their programs, including this event.
My Signature _______________________________________Date ___________
My Full Name Printed______________________________________
My Address______________________________________________________________
*If this release is for a minor, I confirm that I am the legal parent or guardian of the minor named below. I consent to the foregoing on behalf of such minor and personally join in the affirmance of representations set forth above.
Parent/Guardian Signature _____________________________Date ____________
Parent or Guardian Full Name Printed ___________________________________
My Address______________________________________________________________
Minor Name _____________________________________________
Minor Address___________________________________________________________
Minor Date of Birth ____________________________________________________________
PLEASE CONSIDER REGISTERING ONLINE. IT IS THE LOWEST COST!
*COMPLETE THE REGISTRATION FORM
*ONLY ONE PERSON PER REGISTRATION FORM
*PHOTOCOPIES OF REGISTRATION FORM ACCEPTED
*REGISTRATION FEE IS NON-REFUNDABLE
*PLEASE DO NOT STAPLE CHECK TO FORM
*ALL CORPORATE TEAM MEMBER FORMS OR USATF FORMS MUST BE MAILED TOGETHER WITH THE TEAM REGISTRATION FORM
*Mail-in Entry fees
5k Run & Walk
$22 if postmarked by 8/1/2008
$24 if postmarked by 9/1/2008
$25 if postmarked after 9/1/2008 DO NOT MAIL AFTER 9/13/2008
Youth Races
$11 if postmarked by 8/1/2008
$12 if postmarked by 9/1/2008
$13 If postmarked after 9/01/2008. DO NOT MAIL AFTER 9/13/2008
Do not mail after 9/13/2008
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