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2016 Garden Village Splash and Dash and Fun Run
Registration Form

 Choose Race:
 SPLASH & DASH 
FUN RUN
First Name: *
Last Name: *
Address Street 1: *
Address Street 2:
City:
Zip Code: (5 digits)
State:
Phone number:
Date of Birth:
Age on Race Day:
  Boy
  Girl
Emergency Contact
 *
Emergency Contact Number
 *
Email:
 T-Shirt Size:
 Youth SYouth M Youth L
Adult SAdult MAdult L
Comments:

Note: One parent or guardian MUST be in attendance of the race.


Online registrants can pay by cash or check on race day.
For questions or more information call
Lou Ciampi Jr.: (570) 654-4040
Tracey McGurk: (570) 477-2666
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