2nd Annual
American Legacy Academy
5K Run/Walk and Kids Fun Run

Step 1 of 2 (one entry per application)

Race: 5k Run 5k Walk Kids Fun Run		AGE DIVISION Run/Walk Kids Run 11&under 0-2 12-14 3-4 15-18 5-6 19-24 7-8 25-29 9-10 30-34 11-12 35-39   40-44   45-49   50-59   60+
Last Name:	First Name:
City:	State:  State... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming    Zip:
Gender: Male Female    Birth Date: -M 01 02 03 04 05 06 07 08 09 10 11 12 -D 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 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 YEAR 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009    Age:
Shirt Size:   Adult S M L XL XXL(add $2)   Youth:  S M L
Phone:	Email:
Electronic Signature: In consideration of my entry, I, my executors, administrators, and assignees, wave and release American Legacy Academyand all sponsors and others indirectly involved in the event from all rights, claims, liabilities, damages and pain or illness suffered by me, while participating in the event. I attest and verify that I am physically fit and have trained to participate inthis event. I also understand that all registration fees are absolutely non-refundable.
Check One: I am at least 18 years old   I am the parent/legal guardian of the participant
Proceeds from race will benefit: American Legacy Academy, a private school dedicated to small classroom sizes and teaching religious and patriotic principles. *T-shirts are only guaranteed to early registrants (before April 23). They are available to other runners on a first come-first serve basis on day of race. Kids t-shirts are only available for early registrants.