Jack-O-Lantern Jog Registration   -  October 31, 2020


Must be postmarked by October 24, 2020.


Name_____________________________________________      Phone ___________________________________

Address _______________________________________________________________________________________

City ___________________________________              State _______                  Zip code ______________________

Email _________________________________________________________________________________________

Team Entry:  Yes ______ No ______     Team Name ________________________________________________

Sex  _________      Age on Race Day __________    Heavyweight  _______________________________

I hereby attest that I am physically fit and have sufficiently trained for this race/walk event.   I hereby waive any and all rights and claims for damages I may have against the sponsors, directors, and all groups associated with the event

Signature ________________________________________________ (parent/guardian if under 18)


I hereby grant permission for any photo taken of me during the race to be used on the Community Scholarship Foundation of Canon-McMillan's website, Facebook page and in any and all press releases

Signature ________________________________________________ (parent/guardian if under 18)

Shirt Size:              Youth M ______  Youth L ______                           Adult  S____  M _____ L _____ XL _____ XXL_____

Registration  5K Race/Walk Entry @ $28.00 each                                 _______

Registration Skeleton Stroll @ $23.00 each (not scored)                     _______

                                                 Subtotal                                                               _________

XXL T-shirt Fee ($2.00 additional)                                                                   _________

                                                                                TOTAL                                          __________

Make checks payable toCSFCM  (Community Scholarship Foundation of Canon-McMillan)  Send Entry to Jill Sabol (Jog), 120 Lakewood Drive, Canonsburg, PA 15317