Eleanor Roosevelt High School Climate Boosters

DOS LAGOS
CARNIVAL

EARLY REGISTRATION FEE (Ends Saturday, Sept. 25th) Includes T-Shirt & Gift Bag! 5K/10K Adults $20 5K/10K Students Grade K-12 $10 1 Mile Fun Run Adults $10 Students Grades K-12 $5 4 & Under Free!	LATE REGISTRATION FEE (Starts Sunday, Sept. 26th) Last Day of Online Registration Oct 6th! 5K/10K Adult $25 Student Grades K-12 $15 1 Mile Fun Run Adult $15 Students Grades K-12 $5 4 & Under Free!

When registering more than one person,
please make sure to register each person individually.

First Name *
Last Name *
Parent Name (if a minor)
Address
City
State
Zip Code
E-mail Address: *
Contact Phone *
Age (on Oct 9, 2010) *
T-Shirt Size *
Gender *	Male Female
Are you a Student? *	Yes No
School or Group Supporting
From a Club or Organization?
You will participate in *
Number of Children Under 5
Indicate your Division *
How did you hear about us?	Flyer Internet Friend / Relative School Other
WAIVER *	Yes, I agree to the terms of the waiver below


* Required

Please read the waiver carefully and check the box above to accept the waiver.

WAIVER: I agree to the terms of this waiver. In consideration of accepting my entry intending to be legally bound, as the registrant or parent/legal guardian of registrant, hereby waive and release forever Eleanor Roosevelt High School Climate Boosters, Eleanor Roosevelt High School, Corona-Norco Unified School District, Jurupa Community Services, from any and all liability, claims for damages or injuries, death, accident or other occurrence which I may suffer in any manner whatsoever, arising out of or resulting from participating in this event. I expressly assume all risks of our participation.

5K/10K SCHEDULE    • 6:00am - Event Day Check In Begins
   • 7:30am - Warm Up Exercises
   • 8:00am - 5K/10K Runners Begin
   • 8:05am - 5K/10K Walkers Begin
   • 8:10am - 1 Mile Fun Run/Walk Begins

THANKS TO OUR EASTVALE SPONSORS