Entryform Twosome 1

Staley Strider X-Country Twosome Relay Event Sunday October 18th 3:45pm All Ages – Fairview Park Registration starts at 3:00pm at the large pavilion. Runners may also sign up at the Fall Park Runs on Oct. 4th and Oct. 11th. • Tot Trot Cross Country ½ Mile @ 3:45pm $1.00 • Two People Cross Country Relay Event @ 4:00pm $5.00 Two people will make up a team and it can be male/male, female/female, or mixed. See below: Course: One mile cross country loop in Fairview Park. The two people will alternate miles. Each person will run two miles for a team total of four miles. The first runner will run miles 1 and 3. The second runner will run miles 2 and 4 for a combined time. Awards will be given to the top two teams in each relay division. Divisions: Youth (15 & under) Husband/Wife

Adult (16 & up)

Parent/Child

If a child enters with an adult who is not their parent they will be in the adult division. Contact Mike Landacre 217-875-3429 for more information. Note: 2009 Fall Park Runs Oct. 4thand 11th. Registration begins at 3:20pm with ½ mile Tot Trot at 3:45pm. Then the 1, 3, and 6 mile races will start at 4:00pm. (Pleas read through this entry form before completing) Waiver and Release of all claims (waiver must be signed by parent or runner) In consideration for participation in this event, I agree to assume the full risk of any and all injuries, damages, or loss which I or my minor child might sustain as a result of participating in this event, including pre and post race activities. I hereby agree to waive and relinquish any and all claims I or my minor may have as a result of participation in this event against Decatur Park District and the volunteers involved in the event. I further fully release and discharge any and all claims from injuries, damage, or loss which I or my minor child may experience due to participation in this event, including pre and post race activities. I further attest and certify that my minor child or I are physically fit and have sufficiently trained for participation in this event.

#1______________________________________________

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#2______________________________________________

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Runner’s Signature (Parent's Signature if under 18) (Date) Please Print the Following Information

Name#1_________________________________________________________ Name#2_________________________________________________________ Address______________________________________________ City__________________________ State______ Zip________________ Email address__________________________________________ Age#1_______

Age#2_____ Team Name ___________________________

Circle One Youth (15 & under) F/F Adult (16 & up) F/F

Youth M/M Adult M/M

Youth Mix Adult Mix

Parent/Child

Husband/Wife

Form can be mailed to Mike Landacre 489 Buckingham Dr, Decatur, IL 62526 Attn: Twosome Race Registration