PAYABLE TO:  Lily of the Valley Church

        EVENT:  5K Run________      WALK _______

             NAME _______________________________________________ 

              AGE: ______    GENDER:____   PHONE#_____________________

                                                         ADDRESS ____________________________________________

                                                         CITY ________________      STATE ____      ZIP _________          

                                                         EMAIL ADDRESS:_________________________________________

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 Designs LLC, 5904 Keith Dr, Madison Ohio 44057



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