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7/29/2019 Vezina 5k Family Fun Run/ Walk Registration Form
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Vezina 5k Family Fun Run/ Walk October 27, 2013 – 2 PM
Dickinson Park Intramural Fields, CarlislePre-race registration begins at 1 PM
Race course will be along the NEW trail system connecting
Dickinson Fields to Valley Meadows Park .
If you would prefer to register as a family, please use the registration form on the back of
this flyer!
Name: ___________________________________________ Sex Male Female
Birth Date: __________________________ Phone: __________________________
Email: __________________________________________________________________
Address: ________________________________________________________________
City: ____________________________________ State: _______ Zip Code: __________
Enclosed is my registration fee of $15 payable to Vezina Run; minimum
donation to participate is $15, if you should choose to donate more, ALL
proceeds will go to Vezina Family.
This release and waiver is signed on this date: __/__/2013. Knowingly, and at my own risk, I am
participating in the 5k Run/ Walk to benefit the Vezina Family. I waive all claims against the
organizers, sponsors, and volunteers from any claim of injury (including death) that may result
due to my participation. I have knowledge of the risks involved with the event and am physically fit
and have trained accordingly to participate.
Printed Name of Participant: ___________________________________________________
Signature of Participant: _____________________________________________________
Checks should be made payable to: Vezina Run
Mail Registration Forms and checks to: Vezina 5K, PO BOX 813, Carlisle PA
17013 OR bring registration forms on the day of the race.
Questions regarding the race may be directed to Race Organizers at
Aimee Confer Photography
Carlisle mother of four girls, Amy
Vezina, is fighting cancer in her
broken leg. Her out-of-state
medical expenses have proven to
be overwhelming, yet she is
determined to beat the cancer and
get back on her feet. All proceeds
from the Vezina 5k will benefit the
Vezina family.
7/29/2019 Vezina 5k Family Fun Run/ Walk Registration Form
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Family Registration FormDue to the many families that are expected to participate, the race organizers would like to offer an
affordable Family Registration Option.
Parent/ Guardian Name (s): _______________________________________________________________________________________________
Email: ________________________________________________________________________________________________________________________
Address: _____________________________________________________________________________________________________________________
City: __________________________________________________________________________________ State: _______ Zip Code: ____________
Family Member #1
Name: ____________________________________________________________________________________________________ Sex Male Female
Birth Date: ______________________________________________________ Phone: __________________________________________________
Family Member #2
Name: ____________________________________________________________________________________________________ Sex Male Female
Birth Date: ______________________________________________________ Phone: __________________________________________________
Family Member #3
Name: ____________________________________________________________________________________________________ Sex Male Female
Birth Date: ______________________________________________________ Phone: __________________________________________________
Family Member #4
Name: ____________________________________________________________________________________________________ Sex Male Female
Birth Date: ______________________________________________________ Phone: __________________________________________________
Family Member #5
Name: ____________________________________________________________________________________________________ Sex Male Female
Birth Date: ______________________________________________________ Phone: __________________________________________________
Enclosed is our registration fee of $40 payable to Vezina Run; minimum donation to participate is
$40, if your family should choose to donate more, ALL proceeds will go to Vezina Family.
This release and waiver is signed on this date: __/__/2013. Knowingly, and at our own risk, we are participatin
in the 5k Run/ Walk to benefit the Vezina Family. We waive all claims against the organizers, sponsors, and
volunteers from any claim of injury (including death) that may result due to our participation. We haveknowledge of the risks involved with the event and are physically fit and have trained accordingly to
participate.
Printed Name of Parent/ Guardian (s): ___________________________________________________
Signature of Parent/ Guardian(s): _____________________________________________________
Checks should be made payable to: Vezina Run
Mail Registration Forms and checks to: Vezina 5K, PO BOX 813, Carlisle PA 17013 OR bring
registration forms on the day of the race.
Questions regarding the race may be directed to Race Organizers at [email protected]
