Anderson Children’s Foundation & P.S. Lions Club

Present

Run/Walk For Ike 5K

To support the Palm Springs Police Department K-9 Unit

$30.00 DONATION INCLUDES RUN/BREAKFAST/FINISHER DOG TAG AND EVENT T-SHIRT

Age group awards will be presented in the following categories:

10 & under  11-14  15-19  20-29  30-39  40-49  50-59  60-69  70-79  80+

Saturday, May 7^th

8 A.M.

Ramon Alternative Center (next to the P.S.H.S. Auditorium)

2248 Ramon Road Palm Springs CA 92262

Mail or drop off entry to Ramon Alternative  Attention:  RUN FOR IKE

 or Contact Molly A. Thorpe at  Mthorpe@psusd.us (760) 413-6508

Make entry check payable to P.S. Police Dept. K-9 Unit Fund

Event day registration opens at 6:30 A.M. (cash or check)

ENTRY FORM

——————————————————————————Please tear-off and return with entry fee————————————————————————-

PLEASE PRINT

First Name:___________________________    Last:__________________________________

Street address:________________________________________________________________

City:__________________________      Zip:______________        Phone (___)_____-_______

Age:______________             Sex:  M___F___

If you are a P.S.U.S.D.  student, what school do you represent?  __________________________

Shirt size:  Children L_____, Adult  S_____,  M_____,  L _____,  XL_____,  XXL_____

E-mail address_______________________________

WAIVER: (Must be signed by all those over 18 yrs. Or older or by parent/guardian of those under 18 years of age.)  In consideration of my entry for myself, my executors, and assignees, I do hereby release and discharge the Lions Club of P.S., the P.S. Police Dept., The P.S. Unified School District and the Anderson Children’s Foundation, as well as all other sponsors and officials for all claims and damages, demands and actions whatsoever in any matter or as a result o my  participation in said event.  I attest and verify that I have knowledge of the risks involved and am physically fit and sufficiently trained to participate in this event.

Signature________________________________________________Date________________