Registration for for Palisade BEE Festival, Zoo "BEE"lievers 5K walk/run

Zoo’BEE’lievers 5K RACE REGISTRATION

FEE …. $25,  DAY OF RACE, $30

PRE-REGISTRATION includes Tee-shirt

REGISTRATION BY MAIL DUE APRIL 5

Include $2.00 extra,for shirt sizes XXL & XXXL

(No guarantee shirt size for registrations

received after April 3.)

Send this form with check/money orders

To: Children’s Nature Center

       404 Jurassic Ave. A

       Fruita, CO 81521

Attention: Brenda Evers, Race Director

Confirmation of registration

By phone or email.

CASH, CHECK, MONEY ORDER

AGE GROUPS

Circle age on 4/12/2014

Under 14            41 - 50   

14 – 20             51 - 60

21 – 30             61 – 70

31 – 40             71 – 80+

ZOO’BEE’lievers 5K WALK/RUN

RACE BEGINS AT 10 A.M.

AWARDS BEGIN 11:30

Check in at Registration for course starting point.

Name___________________________________

Address_________________________________

City____________________ Zip_____________

Phone ________________ cell_______________

Email___________________________________

Age on the Race day_________  Sex__________

Shirt size   XS   S    M    L     XL   XXL   XXXL

   Remember:($2 extra for XXL & XXXL sizes)

WAIVER OF LIABILITY: READ AND SIGN BEFORE MAILING                  

In consideration of the acceptance of my entry for the

ZOO’BEE’lievers 5 K RACE/WALK, APRIL 12, 2014, I understand 

and agree that any bodily injury, death or loss of personal property 

and expense as a result of my, or the city’s

Negligence is my responsibility. As lawful consideration for 

being permitted to participate in this run, I release from 

any legal liability and agree not to sue, file claim against the 

property of, or prosecute; and to indemnify and hold harmless 

Palisade and all its officers, agents and employees for any and 

all liability, injury, or death caused by or resulting from my 

voluntary participation in the previous mentioned activities. I 

authorize and consent to the publication of myself, whether 

by TV, newsprint, written advertisements or otherwise, of 

any materials contained in my name or picture for participation 

in any event.

Signature of participant ________________________date_______

Signature of parent or guardian_____________________date____

Children's Nature Center

ZOO’BEE’lievers 5K Walk/Race 2014

@ Palisade International Honey Bee Festival