LGHS Band Twilight Trail 5K Fun Run/Walk

Saturday, December 6, 2014 5:30pm

Camp Luther Hill-La Grange, TX
LGHS Band Student Sponsoring: (if any) ___________________________________
If you do not fill in or write legible in the above space your entry will be divided between all students.

Registration Form www.lagrangebandfunrun.com (PLEASE PRINT)

Full Name: __________________________________________________________________
Gender: Male/Female (Circle One) Age: (on race day) ______
Mailing Address:____________________________________________________________

City: __________________________ State: ______ Zip __________

Phone: (_____) _______-________ Email: ____________________________@_________
In Case of Emergency Call: ___________________________ Phone: (_____) _____-_____
How did you hear about our event? ____________________________________________
Shirt Size: (CIRCLE ONE) S M L XL 2XL (please add $2 for 2XL) Sign up by 12/01/14 to
guarantee shirt.
EVENT INFORMATION: The LGHS Band is hosting this 5K as a Fundraiser to help the LGHS Band
Students raise money that will go directly towards their May 2015 Trip to Walt Disney World Florida.
The LGHS Band gets to go on a big trip every 4 years as a reward for their hard work and dedication.
PAYMENT: Secure online payment with debit/credit card: https://endurancecui.active.com/eventreg/select-race?e=11071651 RACE FEE: Early registration $30 or day of event $35 (not guaranteed race
shirt) Please indicate payment method Cash, Check or Money Order payable & send to:
LGISD Attn: Christopher Gongora 820 S Vail St. La Grange, TX 78945
WAIVER: I am aware that participating in an event such as training to run or walk/run, is a potentially hazardous activity, and
that I, (or my child, if I am signing as parent or guardian) should not so participate unless physically able. I verify that I am (or my
child is) medically fit to participate, and will have sufficiently trained for the event prior to participation. I (and my child, if I am
signing as a parent or guardian) agree to abide by the rules and decisions of any event officials relating to participation, and
assume all risks associated with participation in the event and any associated event or activities, including but not limited to, falls,
contact with other participants, effects of the weather such as high heat and/or humidity, traffic, road conditions, all such risks
being known and appreciated. In consideration of acceptance of this non-refundable entry fee, and intending to be legally bound, I
(and my child, if I am signing as parent or guardian) and any one entitled to act on my (or our) behalf (s), assume all risks
associated with participation, and waive any and all claims whatsoever against, and fully release Luther Hill Ministries, La Grange
Mighty Leopard Band, LGISD, program coaches, program volunteers, and all program promoters, and sponsors, and there
representatives and successors, from all claims, damages, or liability of any kind arising my (or my childs) participation in this
event. I grant full permission to any and all to the foregoing to use my (and my childs) name, or photographs, videotapes, or other
recordings or participation in this event, without obligation or liability to me (and my child). I also understand that entry fees are
not refundable. I have read this agreement carefully, understand it, and certify my agreement by signing below.

I AGREE Sign here: _________________________________________________________

(Must wear a head lamp or bring (1) working flash light per participant.)