Uplift Color Run Registration

Uplift Color Run 5K • June 4, 2022 • 8:30AM

Please complete the following information to register for our event. Each Adult over 18 is required to complete this form. If you have minor children, please add them to your form below.
Early Registration closed at 11:59PM on May 9th, 2022. Runners can still register for race only using this form or in person at the following times:
- Friday, June 3 from 6-8PM at Teal Lake Shelter
- Saturday, June 4 from 7-8AM at Teal Lake Shelter
Visit upliftmidmo.org/5k for complete race details and pricing.
Participant 1 (18 and Older) *

First Name Last Name
Age of Participant *
This form cannot be submitted if you are under 18.
Participant Type

Runner Walker Observer/chaperone Volunteer (Racing) Volunteer (Not Racing)
T-Shirt Size *
E-mail *
Contact Number *

Area Code Phone Number
Add Child?* *

Yes No
*Please enter information for all minors that are racing.
Child 1 Name *

First Name Last Name
Child 1 Age *
Child 1 T-Shirt Size *
Add another child? *

Yes No
Child 2 Name *

First Name Last Name
Child 2 Age *
Child 2 T-Shirt Size *
Add another child? *

Yes No
Child 3 Name *

First Name Last Name
Child 3 Age *
Child 3 T-Shirt Size *
Add another child? *

Yes No
Child 4 Name *

First Name Last Name
Child 4 Age *
Child 4 T-Shirt Size *
Add another child? *

Yes No
Child 5 Name *

First Name Last Name
Child 5 Age *
Child 5 T-Shirt Size *
T-Shirts

Runners get a t-shirt with their orders, but if you need extras, or if you're volunteering or observing, make sure to select YES below and let us know your size!
Would you like to order any t-shirts for you or your group that is not racing? ($15 Ea) *

Yes No
Would you like to order any additional t-shirts (shirts come with race registration but additional shirts can be purchased if needed for $15 Ea) *

Yes No

Waiver
This form must be signed by the parent or legal guardian if any minors are listed in this registration. Acknowledgment of the below is doing so on behalf of the main registrant and all minors listed in this registration.

I know that participating in the Uplift Color Run 5K Fun Run is a potentially hazardous activity and I should not enter and participate unless I am medically able and properly trained. I acknowledge and assume any and all risks associated with this event including, but not limited to, traffic on the course route, falls, contact with other participants, and the condition of the course, including, but not limited to, curbs, cars, uneven pavement, potholes, rocks, objects on the course surface, and tortious or criminal acts of any bystander. Knowing and appreciating these risks and in consideration of your acceptance of my entry, I hereby for myself, my heirs, representatives, or anyone else claiming on my behalf, covenant not to sue, and waive, release, and discharge Uplift Mid-MO and the City of Mexico, its volunteers, and sponsors, and anyone else acting for or on behalf the Uplift Color Run from any and all claims of liability for death, personal injury, or damage of any kind arising out of my participation in this run. This Acknowledgement of Risk and Waiver of Liability extends to all claims of every kind whatsoever. I also consent to emergency treatment in the event of injury or illness. I grant full permission for Uplift Mid-MO to use any photographs, recordings, or any other record of this event for any purpose. My signature acknowledges that I have read the above waiver and I agree and accept all terms and conditions set forth herein.
I am over 18 and I agree to the above waiver. *

Yes
Signature (draw with mouse or finger on phone) *

Clear
Signed by *

First Name Last Name
Checkout
Thank you for volunteering. Please use code UCR22 at checkout for a 50% discount on your registration fee or t-shirt. Any additional registrants will be paid at full price.

T-SHIRT IS INCLUDED WITH REGISTRATION IF YOU ARE RUNNING. Volunteer t-shirt is only for non-racing volunteers or observers.
Check the box and enter a quantity for all that apply. *
prev next ( X )
5K Late Registration (12 and Up) $ 40.00
This includes race entry only. T-shirts will be available to purchase as stock allows on race day.

Quantity

5K Late Registration (5 -11 years) $ 25.00
This includes race only. T-shirts will be available to purchase as stock allows on race day.

Quantity

Total $ 0.00
Select payment type below. Payment has not completed until you hit a confirmation page and receive an email. Having troubles? Call (573) 253-6040.

Common Errors: 3D Authentication hasn't been confirmed. Your bank requires a certain authentication and another card will have to be used. If you don't have another card and would like to pre-register and pay upon pickup, email us at contact@upliftmidmo.org.

	Quantity
YOUTH M
YOUTH L
YOUTH XL
ADULT S
ADULT M
ADULT L
ADULT XL
ADULT 2X
ADULT 3X
ADULT 4X

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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Uplift Color Run 5K • June 4, 2022 • 8:30AM

T-Shirts

Waiver

Checkout