Registration

GROVELAND GREAT GRIZZLY 5K/1MILE FUN RUN/WALK EVENT
SATURDAY, APRIL 5, 2008 - 9a.m. at the PLUMSTEADVILLE VOLUNTEER FIRE COMPANY
Please completely fill out one registration form for each participant. Failure to complete entire application will result in
non-registration.

Last Name_______________________________________ First Name_____________________________________

Age on April 05, 2008________________ Gender: M or F (circle one)

Address:______________________________________________________________________________________

City__________________________________________ State_______________ Zip Code_____________________

Class/Teacher at Groveland (if applicable)____________________________________________________________

Event (please circle): 5K Run/Walk (starts at 9:30a.m.) 1mile fun run/walk (starts at 9a.m.)

Registration Fees (please check the ones you wish to participate in):
___ 1 mile fun run/walk: $5 per participant ___ 5k fun run/walk and under age 15: $5 per participant
___ 5k fun run/walk & age 15 or older: $10/participant pre-registration on or before March 24, 2008. $15/participant
race-day registration

Please make checks out to Groveland Home & School Association
Mail Registration and Payment No Later than March 24th to:
Groveland Elementary School - Great Grizzly Run Registration
Attn: Chrissy Grube
1100 North Easton Road
Doylestown, PA 18902

LIABILITY WAIVER AND RELEASE (please read, complete and sign)
I do hereby agree, for myself, my heirs, executors, administrators and assigns to forever remise, release and
discharge the Central Bucks Groveland Elementary School Home and School Association, The Central Bucks School
District and Plumstead Township, its directors, officers, members, supervisors, agents, employees, volunteers and any
other representative related to the Groveland Great Grizzly 5k/1mile Fun Run/Walk Event, including but not limited to
the 5k/1mile run/walk, and their heirs, executors, administrators, and assigns from any and all actions, causes of
action, suits, debts, accounts, controversies, damages, claims and demands, whatsoever, which I or my legal
representative may have or acquire against Central Bucks Groveland Elementary School Home and School
Association, The Central Bucks School District or Plumstead Township or its directors, officers, members, supervisors,
agents, employees, volunteers and any other representatives related to the Groveland Great Grizzly 5k/1mile Fun
Run/Walk Event, including but not limited to the 5k/1mile run/walk, by reason of any loss resulting from personal
injury or property damage, which may occur during, in connection with or by reason of my attendance and
participation in the Groveland Great Grizzly 5k/1mile Fun Run/Walk Event and, in particular, the 5k/1mile fun run/walk.
I agree that the Central Bucks Groveland Elementary School Home and School Association, The Central Bucks School
District and Plumstead Township shall have the right, at its discretion, to enforce rules of conduct and/or terminate my
participation in the Groveland Great Grizzly 5k/1mile Fun Run/Walk Event, for the failure to act in conformance
therewith, or for actions or conduct detrimental to or incompatible with the welfare, comfort, harmony or interests of
the Groveland Great Grizzly 5k/1mile Fun Run/Walk Event.
I hereby grant the Central Bucks Groveland Elementary School Home and School Association, The Central Bucks
School District and Plumstead Township, its directors, officers, members, supervisors, agents, employees, volunteers
and any other representative related to the Groveland Great Grizzly 5k/1mile Fun Run/Walk Event, including but not
limited to the 5k/1mile Fun Run/Walk Event, full authority to take whatever action, in their discretion, is determined to
be necessary regarding my health, safety, and welfare, and I fully release the Central Bucks Groveland Elementary
School Home and School Association, The Central Bucks School District and Plumstead Township, its directors,
officers, members, supervisors, agents, employees, volunteers and any other representative from liability for such
actions, as set forth herein.
I hereby grant the Central Bucks Groveland Elementary School Home and School Association and The Central Bucks
School District and Plumstead Township the right to use my name, photos taken or any other media taken during the
race event for use on its website, in the school yearbook or in any other media (such as newspapers).

Signature of Participant______________________________________________________________________

Printed Name of Participant______________________________________________________ Date______________

All participants under the age of 18 must have a legal guardian sign this waiver.
I give parental/guardian consent to the above registered minor participant to participate in the Groveland Great
Grizzly 5k/1mile fun run/walk event and agree to abide in full to the above waiver:

Parent/Legal Guardian Signature__________________________________________________ Date_______________

Questions? Please contact Chrissy Grube at christinagrube@comcast.net or www.greatgrizzlyrun.com