2018 MOMS Club K-Run for Kids
Monday, September 3, 2018 on the Charlton Town Common. Ages 2-12. Registration is nonrefundable. Race is rain or shine. Note: For the safety of all participants, strollers, skateboards, scooters and skates of any kind are prohibited in this event.

**REMEMBER: In order to complete your registration(s) after this form is filled out, you must follow a separate link to PayPal the MOMS Club by submitting the total amount ($5 x number of child[ren]) to the Club: https://www.paypal.me/CharltonAreaMOMSClub. (Link appears at end of registration).**

Waiver of Liability: In consideration of my/my child(ren)’s entry being accepted, I waive any and all claims for myself, my administrators, and my heirs against all officials, sponsors, and organizations connected with the Charlton Old Home Day and/or the MOMS Club of Charlton/Southbridge for injury or illness that may directly or indirectly result from my participation in this event. I attest that I have full knowledge of the risks involved in this event, and my child(ren) is physically fit and sufficiently trained to participate in this event. I also understand that registration in this event is non-refundable and non-transferable. *
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Participant #1 - Name: *
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Participant #1 Gender: *
Participant #1 Age at Date of Race: *
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Participant #2 Name:
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Participant #2 Gender:
Participant #2 Age at Date of Race:
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Participant #3 Name:
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Participant #3 Gender:
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Participant #4 Name:
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Participant #4 Gender:
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Please include any additional names of child(ren) and their ages:
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Parent/Guardian Name: *
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Parent/Guardian Address: *
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Parent/Guardian City, State, Zip: *
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Would you like to learn more about the MOMS Club? *
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