frogs fun walk registration form

The Friends of the Gum Spring

Library is a Section 501(c)3 non-

profit organization of the Loudoun

County Public Libraries.

FROGS awards scholarships every

year to seniors from local high

schools (Briar Woods High School

in Brambleton and Freedom High

School in South Riding).

FROGS conducts monthly

storytime sessions at the Dulles

South Safety Center in South

Riding.

FROGS relies heavily on donations

from citizens.

Thank you for your patronage and

support!

FROGS Friends of the

Gum Spring Library

Saturday, 19 September 2009

10:00 A.M. to

12:00 P.M. *RAIN OR SHINE*

LCPL FROGS

Friends of the Gum Spring Library

E-mail: gumspringlibrary@msn.com http://gumspringlibrary.blogspot.com

Friends of the Gum Spring Library 43053 Pemberton Square, Suite 120 PMB 144 South Riding, VA 20152

Loudoun County Public Library System

Stone Ridge Community Center

Stone Ridge, VA

Family Fun Walk

Description of the Course: The course is relatively flat and mostly on sidewalks in the Stone Ridge community. Beginning point is the Stone Ridge Community Center. Ending point is the Gum Spring Library site.

Moon Bounce

Face Painting

Raffle Prizes

Balloon Art

The above is an artist's rendering of the Gum Spring Library.

Registration _______________________________________________ NAME

_______________________________________________ STREET

_______________________________________________ CITY STATE ZIP

_______________________________________________ TELEPHONE #

_______________________________________________ E-MAIL ADDRESS

T-Shirts are guaranteed with registrations received by 1 September 2009.

Become a sponsor!

Sponsorship Tiers: (Separate sponsorship form must be received by

1 September 2009 to have name printed on t-shirts.)

$25 TADPOLE level (donor receives: one free child

registration* plus a big thank you on our FROGS website

http://gumspringlibrary.blogspot.com)

$75 LILY PAD level (donor receives: benefits of TADPOLE level plus one free adult registration*)

$200 FROG level (minimum)

(donor receives: benefits of LILY PAD level plus family name or company

LOGO on t-shirt and company link on our FROGS website)

Net proceeds from registrations and sponsorships benefit the Friends of the Gum Spring Library community programs.

Check one: [ ] $9 per child

[ ] $12 per adult

Registrations received after the 1 Sep 09 deadline

and on the morning of the walk will be $12 per child and $15 per adult.

Please circle t-shirt size needed:

Youth S M L

Adult S M L XL XXL XXXL

Make Check Payable to: Friends of the Gum Spring Library 43053 Pemberton Square, Suite 120

PMB 144 South Riding, VA 20152

Walk Release In consideration of the acceptance of this entry, I waive and release any and all claims against the sponsors, cooperating and supporting groups, and any individuals supporting this event. I hold the above individuals and groups harmless for any and all injuries which may result from my participation. I certify that I am physically able to participate in this event. I grant my permission to use my name and/or picture on the Friends of the Gum Spring Library website without limitation and obligation of anyone to compensate me further. Parents/guardians and those 18 and over must sign the release in order to participate in the walk. __________________________________________ Signature of applicant __________________________________________ Parent or guardian signature if under 18

A Morning of Family Fun: * 1.5 mile walk through beautifully landscaped Stone Ridge, ending at the Gum Spring Library site * FROGS Fun Walk t-shirt * Raffle prizes * Face painting * Balloon art * Moon bounce

Race Day Registration begins at 9:00 A.M. at the

Stone Ridge Community Center.

Please share this application with family and friends!

The more, the merrier!

Questions can be directed to Karen Montgomery, Chairperson, Friends of the Gum Spring Library

E-mail: gumspringlibrary@msn.com

http://gumspringlibrary.blogspot.com