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Washington local Schools 2012 Elementary Cross Country Registration

***Due by May 30th 2012***


$15 registration fee (includes shirt, race fee, awards)

Practice begins week of August 27th 2012 WLXC will host 3 or 4 meets on Whitmer campus and at Powertrain Park Divisions

Practice will be twice a week: 45-60 minutes All Meets will be held on a Thursday night (dates/time TBA)

Division Lil Panther Maize Blue

Grades K-1st Grade 2-3rd Grade 4-6th Grade

Distance Mile Mile 1 Mile

Please fill out the bottom portion and return to the designated person at your school below
Meadowvale: Mrs. Hogan Wernert: Mrs. Mueller Hiawatha: Mrs. Lopez Shoreland: Ms. Tuttle Greenwood: Mrs. Shadle Monac: Mr. Bushrow Jackman: Mrs. Pennywitt McGregror: Mrs. Evearitt

--------------------------------------------------------------------------------------------Runners Name:_______________________________ Gender: Female or Male Grade: _______________ School: _________________________ Shirt size: YS YM Ylg. S M L Extra shirt: $10(family members) YS YM Ylg. S M L Are you interested in volunteering? Yes or No (Parents/guardian are encouraged to stay for practices)

Total amount:$ _________


Checks payable to Whitmer High School I as a parent/guardian will be totally responsible for any and all injury medical costs incurred by this student as a result of participation in any extracurricular activity. As a parent/guardian, I acknowledge that participation in extracurricular activities can be dangerous and involve the possibility of serious injury and hereby assume all of the risks associated with participation and agree to hold harmless, the Washington Local School District, its employees, coaches, athletic trainers, representatives, agents, and volunteers from any and all liability.

Please list any medical issues you feel we should be aware of

______________________________________________________________ ______________________________________________________________ ________________

_X___________________________________________________ _______________________________
Signature of Parent/Guardian Date

Contact information: Name:___________________________________ Phone Number: ___________________

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