VT Citizens Track & Cross-Country Run Series Application Form
Please provide the following information (bold fields are required):

Last Name
First Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail

Enter your BIRTHDATE: -- mm/dd/yy

GENDER: Male Female

I will participate in:

Remembrance Run
5000 m Run Burlington Track & Field Invitational
1 Mile Run Burlington Track & Field Invitational
BHS Fun Run
5K for Katie (Essex Invitational)
Burlington Invitational

I know that cross-country running and track are potentially hazardous activities. I should not enter this race unless I am medically able and properly trained. I assume all risks associated with running in this race. In consideration of this entry being accepted, I, for my self, my heirs and administrators, hereby waive any claims I may have against the Burlington High School and Burlington School District, organizers, sponsors or anyone connected with this event for any injury, damage, or loss of property during the conduct this event.

I accept

Enter today's date

- mm/dd/yy

AFTER YOU CLICK ON SUBMIT FORM BUTTON - FORM CONFIRMATION MUST APPEAR ON YOUR SCREEN TO SUCCESSFULLY PROCESS YOUR APPLICATION.
Registration fee may be payed on the race day at the check in.