Shamrock Shuffle 5k
Sat Mar 10, 2018
5k - Ages 18 and over:12:00 pm$22.50
5k - Youth 13-17:12:00 pm$17.50
5k - Youth 12 & Under:12:00 pm$12.50
1 mile fun run:12:00 pmFREE!
BIB #

Shamrock Shuffle 2018 Paper Entry

Note: Lines 1-4 are mandatory. You cannot be entered into the race if they are not complete and legible.
1First Name 
2Last Name 
3Gender   MALE      FEMALE      (please circle one)
4Age(your age on race day)

5Birthday 
6Address 
7  
8City 
9State 
10Zipcode 
11Phone 
12Email 
13
Shirt Size
No Thanks. My shirt drawer is overflowingMens SmallMens X-LargeMens Large
Mens MediumMens XX-LargeWomens SmallWomens Medium
Womens LargeWomens X-LargeWomens XX-Large
14Running Team (if applicable) 
15School and Teacher? (For Hanover St School and Mt. Leb Schools) 

Signature: __________________________________________________________ Date ____________________

Parent Signature (if under 18) ______________________________________ Date ____________________

My signature is in agreement to the following Waiver:

Release and Waiver: I know that running is a potentially hazardous activity. I should not enter and run the race unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risk associated with running including, but not limited to falls, contact with other participants, the effects of the road and traffic on course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, I for myself and anyone entitled to act on my behalf, waive and release the Lebanon Recreation and Parks Department, City of Lebanon, Upper Valley Running Club, coordinating groups, individuals associated with the Lebanon Recreation Shamrock Shuffle, Mass Bay Brewing Co.Inc., all sponsors and their representatives, employees, and successors from all claims or liabilities of any kind suffered in connection with this event. I also hereby grant full permission to any and all of the foregoing to use my likeness in all media including pictures, photographs, or any other record of this event for any legitimate purpose.