3rd Annual BUBBLE AND GLOW L.E.A.P. & 1 MILE FUN RUN/WALK Friday, April 24th Festivities/Registration begins at 6:00 p.m. @ Eldon Middle School – 1400 N. Grand Ave., Eldon, MO 5k & 1 mile fun run/walk begin at 7:30 p.m. All forms & payment must be received by the L.E.A.P. office by April 10th to guarantee a t-shirt. Every participant needs to fill out their own registration form. All Family/Team registrations should be sent in together. Children under 16 must be accompanied by a responsible adult. Registrations can be turned in by your student or mailed to: L.E.A.P. Office, 112 S. Pine St., Eldon, MO 65026 Name:___________________________________________ Age:________ Address:_________________________________________________ Phone #:_______________ Choose one of the following: I am currently enrolled in L.E.A.P. – My registration is free I am an immediate family member (parent/guardian, sibling, grandparent, aunt, or uncle) of a L.E.A.P. student My registration fee is $5 I am a child aged 4 or under – My registration is free (Does not include t-shirt.) I am a community member registering as an individual – My registration fee is $10 I am a community member registering with a family/team of 4 people – Our combined registration fee is $35 I am registering with a family/team in addition to the original 4 members – My registration fee is $5 Total amount enclosed: _______________ Please select size & color for your t-shirt (Family/team members should all wear the same color.) Youth Extra Small Youth Small Youth Medium Adult Small Adult Medium Adult Large Adult XL Safety Green Safety Orange Safety Pink Youth Large Adult XXL Lime Green Adult XXXL Sapphire Blue I understand that participation in any of the events and activities is at my own risk, and that I am fully responsible for my, as well as my children’s, health and safety during this event. I agree that neither L.E.A.P. nor the Eldon School District will be liable for any injuries incurred during the event, damage to personal items, or be responsible for any lost or stolen property. I understand that my children are my responsibility and will not be the responsibility of L.E.A.P. or other school staff. I understand that district rules for sporting and other types of events will apply to me and my children at all times while participating in this event, even when I/we are not on school grounds. Signature of Participant or Responsible Party **For more information call 573-392-8060 ext. 5**