frogs fun walk registration form
TRANSCRIPT
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: [email protected] 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: [email protected]
http://gumspringlibrary.blogspot.com