Registration Form:  Please return to Windsor High School, Attn: Angel Baumann 1424 Minnesota Ave., Windsor, IL 61957 or email to [email protected]

Name: _________________________________________                       Gender: ___ Male   ____ Female

Address: _______________________________________

City: ___________________________________________

State: ________________  Zip Code: _________________

Phone: _________________________________________

Email: __________________________________________

Birth Date: ______________ Age as of Race Day: ________

Waiver:  I hereby affirm that I am in proper physical condition to participate in the Windsor Harvest Picnic 5k.  And, in consideration of the acceptance of this entry, agree to assume all risk of injury to myself and all risk of damage or loss of property arising out of my participation in this event; to release and forever discharge all sponsors and promoters including, but not limited to:  Windsor High School Class of 2020, Shelby County, subcontractors and all volunteers, which may arise from my participation in this event.  I understand that my entry is non-refundable and non-transferable.

Signature:  _____________________________________________________  Date:  ________________                                                    (Signature of Parent/Guardian if under 18)

T-Shirt Size(s): Adult Sizes Only

______ Small

______ Medium

______ Large

______ XL