1. Presented by:
Adult Registration: $25 per person
Kid Registration: $10 per person
Ages 13 and Under
Name: ________________________________________________________
First Middle Initial Last
Address: ________________________________________________________
Street City/State Zip Code
Gender: _____ Male _____ Female
Age Category:
_____ Kids Fun Run / Ages 13 and under ($10 each)
_____ 5K / Ages 13 and under _____ Track Team (No Fee)
_____ 5K / Ages 14 to 24 _____ 5K / Ages 35 to 44
_____ 5K / Ages 25 to 34 _____ 5K / Ages 45 and up
Preferred t-shirt size:
Youth sizes _____ XS _____ S _____ M _____ L
Adult sizes _____ XS _____ S _____ M _____ L
_____ XL _____ XXL
Please make checks payable to St. Charles Borromeo Catholic School and mail with registration form to
St. Charles Challenge c/o 1006 Goodyear Boulevard, Picayune, MS 39466.
Preferred t-shirt sizes are only guaranteed if registration is received prior to August 1st
. Packet pickup
available on Friday, August 9th
from 5:00 p.m. until 7:00 p.m. at St. Charles Borromeo Catholic School
and on race day from 7:00 a.m. until race time. The race start and finish will be at St. Charles Borromeo
Catholic School.
I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I
agree to abide by any decision of a race official as to my ability to safely complete the run. I assume all risks associated with running in this
event including but not limited to falls, contact with other participants, the effects of the weather, including heat and/or humidity, traffic and the
conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration
of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release St. Charles Borromeo Catholic School, and
all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participating in this event. I grant
permission to all of the foregoing to use any photographs, motion picture recordings or any other record of this event for any legitimate purpose.
_____________________________________________ ______________________________
Signature (Parent or Guardian if under 18) Date