Registration Application
Chibi-K: Kids for Kids Fun Run
Saturday, May 8, 2004

Registration starts: 7am
Program Begins: 8am
First Race begins: 8:30am
Event Ends: 10am

 


Early Saturday morning children ages 4-12 will fill the streets of Little Tokyo in the Chibi-K: Kids for Kids Fun Run. The run fees Includes breakfast. Be sure to register early!

Special Guests include senior track star Sumi Onodera and T-Bone. Disney characters Pluto and Goofy are scheduled to make an appearance.

Chibi-K Registration fees: $10 JACCC Members, $20 General, $25 Day-of-Registration.
Please bring a new unwrapped toy to be donated to organizations serving children.

Make checks payable to the JACCC: 244 S. San Pedro Street #505, Los Angeles CA 90012
Sorry, but we are NOT able to take online credit card payments at this time. You may complete the form online so that we may reserve a space for your child/children and either call us at (213) 680.3700 to charge by phone or mail a hard copy of the registration form with the parent/guardian signature and a check.

For more information please contact Kym Aoki at the JACCC, (213) 628.2725 ext. 112

Runner #1 Name  Age

Division
1/4K (4yrs) 1/2K(5-6yrs) 1K (7-9yrs) 1K(10-12yrs)
T-shirt Size      
*Parent/Guardian   Date

Runner #2 Name Age 

 Division
1/4K (4yrs) 1/2K(5-6yrs) 1K (7-9yrs) 1K(10-12yrs)
T-shirt Size      
 *Parent/Guardian Signature    Date  

Parent/Guardian Contact Information  
Parents/ Guardian Name Date
Address  Day Phone
City, State, Zip

Evening Phone

Chibi-K Fees:

      
$10 JACCC Member
Member Number:
$20 General Admission
   

Total Amount  $

  
   

*Parent/Guardian Waiver Release From Liability:
As parents or legal guardian(s) of the above registered child or children, I hereby certify that the child/children are within the above specified age group and hereby agree to allow him/her to participate in the Chibi-K: Kids for Kids Fun Run. I absolve JACCC, LTRC and all sponsors and donors and/or their respective officers, agents, representatives, successors and/or assigns from any liabilities or responsibility for any damage or personal injuries that might be sustained while participating in, traveling to and from, or connected with these events. Also, I consent to allow medical treatment in case of any emergency.