Early Registration Fee: $10 (before 1/25/06)
Late Registration Fee $12 (after 1/25/06)
Online Registration
Or fill out the registration form below
and turn it in with your fee

Last Name: _______________________________ First Name:________________________________

Address: __________________________________________________________________________

City: _________________________________________State: ___________  Zip: ________________ 
Date Of Birth: ___________________ Age: __________ Phone: ______________________________ 

Email: _____________________________________

SCHOOL NAME: ____________________________________________________________

Categories - Check One                                                                                 Circle One:        T-Shirt Youth
______    Pee-Wees: Ages 7-8 - Run 1/2 mile, Bike 3 miles, Run 1/2 mile      Boy    Girl            S    M    L
______    Bantum: Ages 9-11 - Run 1/2 mile, Bike 6 miles, Run 1/2 mile        Boy    Girl            S    M    L
______    Juniors: Ages 12-14 - Run 1 mile, Bike 6 miles, Run 1 mile             Boy    Girl            S    M    L
______    Seniors: Ages 15-19 - Run 2 miles, Bike 10 Miles, Run 1 Mile         Boy    Girl            S    M    L

EQUIPMENT REQUIRED - Mountain Bike, Helmet, Water Bottle or Hydration Pack

Mail Non-Refundable Check & Form to: Brownsville River Rockets 200 Santa Ana #9, Rancho Viejo, TX  78575-9751
c/o Evelyn Cameron, President
rracmembership@yahoo.com  956-466-5288

WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY -  OFFICIAL WAIVER:
I certify that my child is capable of completing all disciplines of the event. As Parent/Guardian, I hereby take the following action for myself, my executors, administrators, heirs, next to kin, successors and assigns, or anyone else who might claim or sue on my behalf, and I hereby waive, release and discharge from any and all claims, losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bills, or theft which may arise out of or relate to my child’s participation in this event. I agree not to sue, and to hold harmless any and all persons, clubs, sponsors, volunteers, participants or government agencies for any and all claims or liabilities that I have waived, released or discharges herein.

Parent/Legal Guardian:

Name:_________________Signature________________________________Date:_____________________

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