Affidavit of Proof of Age

As a parent and/or guardian of _______________ I swear that he/she was

Racers Name
born on the ____________day of ________________ in the year ________.
Day Month Year

If in the case that proof of this date of birth is requested I will provide said proof within

5 days. This proof will be in the form of a birth certificate. Failure to provide this proof

of age will result in me and my child being barred from future Strider Races and will

void any race placements, awards or prizes previously achieved by this racer.

Racer Name (printed):__________________________________________________

Parent/Guardian Name (printed):_________________________________________

Parent/Guardian Signature:________________________________________