Pittsford Recreation Department - Trail Run Registration Form 5k & 1 mile
P.O. Box 10, 426 Plains Road, Pittsford, VT 05763
483-6500 ext. 17 www.pittsfordvermont.com

PLEASE COMPLETE ENTIRE FORM - Only one form needed per family, please fill out additional forms for adults/children not in the same family. Pre-register by April 7, 2017 to be guaranteed a t-shirt.

Email Address:
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Participant 1 Name:
Please include names and ages of all participants. Top finisher prizes will be awarded in Adult and Youth (12 and under) categories.
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Participant 1 Age:
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Participant 2 Name:
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Participant 2 Age:
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Participant 3 Name:
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Participant 3 Age:
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Participant 4 Name:
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Participant 4 Age:
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Participant 5 Name:
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Participant 5 Age:
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Address
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Home Phone
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Cell Phone
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Emergency Contact Name and Phone Number
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ALLERGIES OR CONDITIONS WE SHOULD KNOW ABOUT:
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Shirt Size
Please indicate Requested Shirt Size. Shirts are ONLY guaranteed to participants pre-registered by April 7, 2017. All other shirts are first come-first served on race day. Shirts will be available and distributed on race day upon registration.
Required
Questions/Comments:
Please indicate here if you need more than one of the shirt sizes listed above.
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Fee Payment Options: Pre-Registration by April 7, 2017 assures participants a Race T-shirt.
Submit the proper fees to the Town Offices Mon-Wed 8 am-4:30 pm, Thurs 8 am-6 pm & Fri 8 am-3 pm. You can also call with credit card information (fee applies), mail it, or drop it in the After-Hours Drop Box located near the exit of the Town Offices parking lot.

Pittsford Town Office, P.O. Box 10, 426 Plains Rd, Pittsford, VT 05763

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Fee(s)
Entry fees: Pre-register by April 7, 2017 to be guaranteed a t-shirt - $10 for 5K – $5 for 1mile *Race day registration - $15 for 5k – $10 for 1 mile. Payment options listed above.
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PLEASE READ CAREFULLY - RELEASE:
I understand there are risks of physical injury in participating in sports and recreational activities. I hereby release the TOWN OF PITTSFORD, its employees, and agents from any liability or personal injury, or loss or damage to personal property which I or my child may experience in connection with activities sponsored by the Pittsford Rec. Dept. I hereby consent to any medical procedures deemed advisable for myself or my child in the event I sustained an injury. The dept. does not provide accident or hospitalization insurance for participants of its programs. All participants are advised to have adequate personal coverage. Please consider ones own health, experience, and tolerance for risk before participating in any Recreation Program. I hereby consent to the use of photos/videos of myself or my child by the Department for flyers or presentations.
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