Great Pumpkin Entry Form: First Name: ____________________________________ Last Name: _____________________________________ Male: _____ Female: _____ Age on Race Day: _______________________________ Address: _______________________________________ City: _____________________ St: ____ Zip:_______ Phone: _________________________________________

____ 5k Run	____ 1m Run	____ 5k Walk	____ 1m Walk
T-Shirt	Adult Youth	S___ M___ L___ XL___ XXL___ S___ M___ L___
___ $15 Adult Race Entry ($20 if late) ___ $10 Child (13 and under) ($15 if late) ___ add $5 for Outback Dinner for race participant ___ add $10 for Outback Dinner for non-race participant Tickets for the Outback Dinner are on a first come, first served basis. Limited supply.
In consideration of your accepting this entry, I hereby waive all claims against Northwest Children's Home, associated sponsors, and any of their personnel for any injury I might suffer in this event or in route to or from the event. I hereby attest that I am physically fit and sufficiently prepared for completion of the event. Further, I hereby grant full permission for sponsors and organizers to include pictures of me and quotations from me in any legitimate accounts of the Great Pumpkin Race and in promotion thereof. Signature: ____________________________ Date: ________________________________ Parent/Guardian (if applicant is under 18) Signature: ____________________________ Date: ________________________________ Please make checks payable to "Northwest Children's Home" and return registration forms to the following: Northwest Children's Home 504 E. Florida Ave. Nampa, Id 83686 (208)463-0916