Checks Payable to:  Lily of the Valley Church

NAME:__________________________________________       GENDER:_____    AGE:_______

ADDRESS:_______________________________________     City:____________  STATE:____  ZIP:_______

EMAIL ADDRESS:_____________________________________________      PHONE:____________________

Shirt Size:_______________ (You must be within the first 50 Registered to receive this shirt)

I accept that I compete in this event at my own risk and I hereby waive and release the Event, The City of Geneva, all sponsors, contributors, supporters, volunteers and officials associated with the event from all rights and claims for any accident, injury or loss suffered as a consequence of my participation.


Date: ____   Signature:_______________________________

Parent’s Signature (under the age of 18) ____________________________

You can drop of your registration fee & form off at Buckeye Auto Sales of Geneva OR mail it to

SweetPea’s Organizer:  Float Away Design LLC, 5904 Keith Dr, Madison Ohio 44057


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