Name: 
      Address: 
         City: 
        State:    Zip: 
Daytime Phone:  Date of Birth:  Age on race date: 

       Gender: M F
        Event: 5K Run/Walk1.5M Run/Walk
 T-shirt Size: S M LG XL 
               Child LChild M

E-mail address:___________________________

Team name:___________________________ (only if part of a team)*

*Note: Team members will not be eligible for individual age contests. 

St. Luke School Alumnus? Please give last year/grade __________________ 
                                                       (ex:1976/5th)

Waiver Must Be Read and Signed Before Mailing:
I assume all risks associated with running in this event including, but not limited to falls, contact with other participants, the effects of the weather, traffic, and conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I hereby release Barrington, Barrington Police Department, St. Luke School, St. Luke Church, Race Officials, Volunteers and all Sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event.

_______________________________  _____________ _____________________________________
Signature                        Date          Parent's Signature if under 18