Name_________________________________________________


Address_______________________________________________


City_______________________State__________Zip___________


Phone____________________Email________________________


Birthdate_______________Age (on 10/18/08)______M____F____


T-shirt size  YS(6-8)   YM(8-10)   YL(10-12)   AS  AM  AL  AXL  XXL

I would like to order a T-shirt but WILL NOT be participating in the 5k or fun run/walk 

No guarantee of T-shirt after September 30, 2008


Fee Enclosed:  $15.00 Make check payable to Trinity Mother’s Club.

Turn Registration Forms into Teresa Whitehead in main office or mail:

Teresa McNatt

17 Rawling Wood Cove Jackson, TN 38305

Questions please call: 731-695-4581

Release and waiver (Please Read and sign)

I know that running is a potentially hazardous activity.  I should not enter and run unless I am medically able

and properly trained.  I also know that, although police protection might be provided, there could be traffic on

the course route; therefore, I assume the risk of running in traffic.  I also assume any other risks associated

with running this event including, but not limited to, falls, contact with other participants, and the effects of

weather and conditions of the road.  I understand I am solely responsible for my own safety while traveling

to and from or participating in this event.

Knowing these facts and inconsideration of your acceptance of my entry, I hereby for myself, my heirs,

executors, administrators, or anyone else who might sue on my behalf covenant not to sue, and waive,

release, and discharge the sponsors or contributors to this event, any race officials, volunteers, the city and

police agencies, their representatives successors or assignees from any and all claims of liability for death,

personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of my

participation.  The release form and waiver extends to all claims of every kind or nature whatsoever, foreseen and

unforseen, known and unknown.  The undersigned further grants full permission to use any photographs,

videotapes, motion pictures, recordings, or an other record of the event for any purpose.  Minors will be

accepted with a parent’s signature.


_______________     ______________________________________

Date                            Signature (Parent/Guardian must sign for minors)