SWRC 2005
Third Annual Wild Goose Chase
Pre-Registration Form
Deadline: Friday, June 18

PRINT this page, fill it out, and mail it along with your check (payable to SWRC) to:

Wild Goose Chase
P.O. Box 126
Willow Grove, PA 19090-0126

The 3rd Annual Wild Goose Chase
5K Cross Country Run - $15 ($20 day of event)
1 Mile Bird Walk - $10 ($15 day of event)
9:00 am, Saturday, June 25, 2005
Germantown Academy
Fort Washington, PA

Make checks payable to:
Wild Goose Chase
P.O. Box 126
Willow Grove, PA 19090-0126

Last Name:
First Name:
Circle One:	MALE	FEMALE
Age on 6/21/04:
Street Address:
City:
State:
Zip:
Phone:
e-mail:
	Activity	Pre-Registration Fee
Circle all activities you are registering for:	5K Run	$15
	1 Mile Walk	$10
	Wildlife Education Program
	Adult	$10
	Total # Children_______	$5 per child	Ages__________________________

Total Fee Enclosed:	$____________
Date:
Signature: (Acceptance of Waiver below)

WAIVER

By signing above, I agree to assume all responsibility for all risk of damage or injury to me as a participant in this event. In consideration of being accepted as an entrant in this event, I hereby, for myself, my heirs, executors and administrators, release and discharge Germantown Academy, the race directors and volunteers, and any and all other individuals, municipalities, and all other organizations associated with the race from all claims, damages, rights of action, present or future, whether the same be known, anticipated, or unanticipated, resulting from or arising out of, or incident to, my participation in this event. I hereby certify that I will not participate in this event unless I am physically fir and sufficiently trained for competition in the race. I understand that this year the course of the run will be Germantown Academy's home cross country course. The first and last miles of the run will be on the grass, and the middle miles on the wooded trails with one slight hill. I also understand that bicycles, skateboards. baby joggers or strollers, roller skates or blades, animals, and radio headsets are dangerous and should not be used while running.

©2002,2003,2004,2005 The Schuylkill Wildlife Rehabilitation Clinic
Website by: Chris Mills
Photography by: C.Mills & SWRC Volunteers
Page last revised: 2/24/05