Easy As Pie 5K

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Team name   First name   Last name   Email address   Date of birth    MM 01 02 03 04 05 06 07 08 09 10 11 12    DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    YYYY 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920    Gender -- Male Female Other   Hometown Other   -- AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT   Emergency contact name   Emergency phone #   Category Choose one 1-10 11-15 16-19 20-29 30-39 40-49 50-59 60+   Event entry fee TBD

Would you like to make an additional donation to the Brooktondale Community Center? NoYes USD Want to purchase a T-shirt for $6? NoYes 6.00 USD T-shirt size Choose one Youth Small Youth Medium Youth Large Adult Extra Small Adult Small Adult Medium Adult Large Adult Extra Large

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver By clicking "I accept the terms of the waiver" below, I accept full responsibility for myself and for any injuries I may incur during the Easy As Pie 5K. I realize that road racing is a potentially dangerous activity. I will not hold the Caroline PTA, Brooktondale Community Center, nor any of its sponsors, volunteers, affiliates, nor race course land owners, responsible for any mishaps that may occur. I further verify that I have sufficiently trained for this event, and understand that professional medical attention may not be immediately available. I grant the race organizers permission to use my name and any photos or video of me in what ways they see fit. I acknowledge that my entry fee is nonrefundable; even should the race be canceled due to extreme weather or unforeseen act of mankind. I accept the terms of the waiver Name of parent or guardian who approves this activity