21st Annual
Dreamcatcher Classic
Road Race & Fun Run/Walk 

Entry Form

                                   Name:_________________________________________________

                                  
                                  Address:________________________________________________

                                
                                  City/Town:_______________________________________________

                                
                                  State:_______________________Zip Code:____________________

                                 
                                  Age:_______Sex:_______ Telephone:_________________________

                                    
                                  E-Mail___________________________________________________                                  
                                 
                                
                                 5-Mile____2-Mile____Wheelchair:____Donation:____Volunteer:_____

                              Preregistration $25.00 until Fri. Nov. 22, 2013    Post registration $30.00 Race Day

    In consideration of your accepting this entry, I hereby for myself, my heirs, my executors, administators,
    waive and release any and all claims for damages I may have against the Julie Rodick Road Race/
    Scholarship Foundation, any sponsors, and any individuals associated with this event, and will hold them
    harmless for any injuries that suffered in connection with the Julie Rodick Road Race/Scholarship Foundation.


       _________________________________________________________________
       Signature (Parents if under 18 years of age) 

       Make check payable and mail to:     Julie Rodick Scholarship Foundation
                                                               P.O. Box 176
                                                               S. Weymouth,  MA  02190
                                                              
                                                               781-331-0600
                                                               E-mail:  DrCtchr@aol.com

                You may also sign up at www.coolrunning.com or clicking on the following link-