2022 Pre-Reg 5K
2022 5K Tater Trot/ Spud Run
All of the proceeds from this years 5K will be donated to assist SLV Pediatric Diabetes Patients! Registration is $25/participant. T-Shirt sizing is limited and while supplies last; register today! If you plan to pay via cash/check: money MUST be delivered to the CPAC office (1305 Park Ave., Monte Vista CO 81144) prior to event!
Name
First Name
Last Name
Email
example@example.com
Special Concerns (allergies, medications, medical conditions, etc.)
EMERGENCY CONTACT (Please list Name and Phone Number)
T-Shirt sizes are limited, please mark your preferred size below (adult sizes) (PLEASE specify children sizes in "Other" box):
Small
Medium
Large
XL
Other
Payment Method (Cash and Checks must be delivered to the CPAC office prior to event)
PayPal (link below)
Cash
Check
Other
Advisement:In consideration for participating in the City of Monte Vista’s Recreation programs or using parks and/or facilities, the undersigned, on behalf of himself/herself and his/her heirs, successors, representatives, and assigns, hereby expressly exempts and releases, and agrees to indemnify and hold harmless, the City of Monte Vista, its officers, employees, volunteers, insurers, and self-insurance pool, from and against all liability, claims and demands, either past, present or future, which are incurred, made, or brought by himself/herself or any other person or entity, on account of damage, loss, or injury, including without limitation claims arising from property loss or damage, bodily injury, personal injury, sickness, disease, death, or any other loss of any kind whatsoever, which arise out of or are in any manner connected with the participation in the program(s) or use of the facilities. I give my permission (w/o any compensation) to use any photographs, film footage, tape recording which includes my child’s, voice or likeness to promote the City of Monte Vista’s programs. ** I have read the above waiver and understand the contents**I hereby grant the City of Monte Vista permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
*
Signature (If participant is UNDER 18 years of age, must be legal guardian signature)
DateTime
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