Carmel Challenge Cup Saturday, November 22, 2008 8 AM  1 mile walk-run   ·   8:30 AM  5K race REGISTRATION $15 PER PERSON RACE DAY REGISTRATION $16 PER PERSON NO T-SHIRT OPTION (Race Day only)   $8  PER PERSON		MCA STUDENTS ONLY:  HMRM ____ Other participants:  Give credit to __8     __9     __10     __11     __12
		T-SHIRT SIZE (check one): __YL   __S   __M   __L   __XL   __XXL

FAMILY NAME _____________________________  FIRST NAME _____________________  PAID _______ MAILING ADDRESS __________________________________________________  TELEPHONE _________ CITY ______________________________  STATE _______  ZIP+4 ___________     In consideration of the acceptance of this application form, I, the undersigned, intending to be legally bound, do hereby for myself my heirs, executors, administrators and assigns, knowingly and willingly waive any and all rights and claims for damage I may have against persons or entities connected with this event, including Mount Carmel Academy and other sponsors, and I release and hold them harmless from any liability for any and all injuries sustained in connection with this event.     I hereby grant full permission to use my name and image in any photographs, video tapes, motion pictures, recordings, broadcasts or other records of event, and that my physical condition has been verified by a licensed physician. Send this form with check to:  MOUNT CARMEL ACADEMY · 7027 MILNE BLVD · NEW ORLEANS, LA  70124 _____________________________________ SIGNATURE   _____________________________________ IF UNDER 18, SIGNATURE OF PARENT/GUARDIAN

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