10th Annual Spartan 5K & Half Marathon Saturday May 6th, 2017 Community School of Davidson Where: Davidson Town Green Half Marathon – 7:30am 5K – 8:30am For further information or to register online go to csd5k.wordpress.com or complete and return this form along with payment to the Elem School or HS School front desk or mail along with payment to CSD, 404 Armour St, Davidson, NC 28036 Attn: Jill Cashion. If you are registering more than one runner please use separate form. You may write one check. Payable to CSD

Last Name ________________________________ Date of Birth ______________ T-shirt size(circle one)

YM

Gender M YL

S

M

L

F

First Name _______________________ Age on Race Day ________________

XL

City _____________________ State ________________ Zip Code _______ Phone ____________________ E-mail address _____________________________________ Emergency Contact Name ________________________ Phone ________________________ Circle one Half Marathon

5K

Half Marathon $45 before 1/1/2017 $50 1/1/2017 – 3/31/2017 $55 4/1/2017 – 5/5/2017 $65 Race Day

5K $20 before 1/1/2017 $25 Adult/ $20 Student(18 & under) 1/1/2017 – 5/5/2017 $30 Adult/ $25 Student(18 & under) Race Day

Total Due

Check # 2017 Spartan Half Marathon & 5K Road Race Liability Waiver:

In consideration of my entry in the Spartan Road Race being accepted, I intend to be legally bound, and to hereby for myself, my heirs, executors, waive and release all rights and claims for damages which may have or which may hereinafter accrue to me against Community School of Davidson, their employees, and of their respective officers, agents, directors, volunteers, sponsors, representatives, successors, assigns, for an and all damages or injuries which may be sustained and suffered by me in conjunction with my association with entry or participation in the Spartan Road Race events as mentioned above. If I should suffer injury or illness, I authorize officials of the race to use their discretion to have me transported to a medical facility, and I take full responsibility for these actions. I attest and certify that I am physically fit and have sufficiently trained for the completion of this event. I HAVE READ THE ABOVE RELEASE AND UNDERSTAND THAT I AM ENTERING THIS EVENT AT MY OWN RISK. Signature of Participant (Parent or Legal Guardian if under 18)

Date: