Raynham Knights of Columbus

Please fill out the following questions and print out this page.

Once printed mail to:
John Donahue
195 Hickory Dr, Raynham MA 02767
Raynham, MA 02767

Make checks payable to St. Ann Knights of Columbus ($18.00 for mail in, $20.00 day of race)

Last Name

First Name

Age Sex

Address

City State Zip

Email

T-Shirt Size

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2. Large
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4. XX-Large

In consideration of the acceptance of this entry in the Raynham Knights of Columbus Charity Road Race, I waive all claims for myself, my heirs and estate against all officials, organizers, sponsors, the Town of Raynham, The American Legion and the Knights of Columbus for any injury or illness, which may result from my participation in this race. I also state I am in proper physical condition to compete in this race. No one may enter this race without signing this waiver.

___________________________________________________________________________
Signature (of parent or guardian if entrant is under 18)

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