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Run to Play! 5K Run/Walk
West Boylston, MA

Pride Park 5K Run/Walk Registration Form

Name: ____________________________________________________________
Sex (circle one): M / F
Address: _________________________________________________________
Address: _________________________________________________________
Phone Number: ____________________________________________________
Participation (circle one): Run / Walk
Age on Day of Race (required): ________
T-Shirt Size (circle one): M / L / XL
Base Registration Fee per entrant : $15.00 or $18.00(After May 1)
(each entrant must complete separate form)
Total enclosed: $___________

Please enter me in the 5K Run/Walk for the Renovation of Pride Park Community Playground. I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event. In consideration of being accepted as an entrant, I hereby, for myself, my heirs, executors and administrators, release and discharge the Town of West Boylston, the Pride Park Renovation Committee, the Central Mass Striders and any and all other individuals, entities, and organizations associated with the race from all claims, damages, rights of action, present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of, or incident to, my participation in this event. I hereby certify that I will not participate in the 5K Run/Walk for the Renovation of Pride Park Community Playground unless I am physically fit and sufficiently trained. I also grant permission for the use of my name and or picture in any broadcast, photograph or other account of this race. I understand that (except for the walk) bicycles, skateboards, baby joggers, or strollers, roller skates, or blades, animals and radio headsets are not allowed in the race and I abide by this guideline.

Signature_____________________________________________________    Date:________________
(required)
Parents signature Required if under 18 years of age
Please Mail Form and Check to: Pride Park Renovation Committee, PO Box 169, West Boylston, MA 01583

Make Checks Payable to: Town of West Boylston/Pride Park

For more information: or call Becky 508-835-6199 Or Julianne 508-835-8830