Name: _________________________________

Address: _________________________________

City, State, Zip: _________________________________

Daytime Phone #: _________________________________

Email: _________________________________

 

Age: __________

Gender: M / F (circle one)

T-shirt size: S M L XL (circle one)

Participant type: [ ]Runner [ ] Walker [ ] Donation

Entrance Fee: (cash or check payable to “Miles For Kyle”):

Run: Adults $20

Kids free under age 12

Walk: Adults $20

Kids free under age 12

 

I understand that running is a potentially hazardous activity. I should not enter or run this event unless I am medically able and properly trained. I assume all risks associated with running in this race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. I waive and release “Miles for Kyle", and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event.

_________________________________
Sign/date (parent must sign if participant is under 18 yrs old)

Mail form and payment to:
Miles for Kyle
c/o Mark Butt
43 Crosman Avenue
Swampscott, MA. 01907