Race Against Violence

On this day, we will have activities for children and adults such as free face painting and bounce house for them, and they will have an opportunity to receive educational resources. We will have speakers who will talk about Domestic Violence and survivors will give testimonies of their experiences. This day is where we want to bring together the community to talk about family Violence and the impact that it has on our communities and the need to find a solution to create a community without domestic/interpersonal violence. A community that has vibrant individuals and families who are resilient and have a sense of belonging, acceptance and connectedness to self, family, the community, and society.

Race Date: August 26, 2023

Location: Panorama Park 4540 Fenton Rd. 80916

Start Time: 9:00 am
Participant Information
Full Name

First NameLast Name
Age
Date

MonthDayYear
Date
Pronouns *
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-Shirt Size*

XSSMLXLXXLXXXLXXXXL
Underaged Racers
If any underaged racer will be in attendance with you please list their name(s) here. Please, also include them in your payment fee.
Emergency Contact Details
Contact Person*

First NameLast Name
Phone Number*
Relationship*
Race Style *
Please select if you will be running or walking
Please note that animals are allowed at this event. If you are interested in bringing your animal please include them in the description box below as well if you will be running/walking with your animal.
The fee includes; a t-shirt, water bottle, race bib, and swag bag.

Payment

Registration FeeIf you use a credit card there is a 2.6% fee applied to your payment. All prices have been adjusted to cover the amount taken.

$55.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Waiver Release

I confirm that I am in good shape, health, and condition.I don't have any medical condition or medical history that will affect my participation in this eventI acknowledge that this road race requires physical activity and there are possible risks and danger.I release the road race event organizers for any responsibility in case of an accident, illness, or injury.I confirm that all information in this registration form is accurate and true.Read this Acknowledgement of Risk and Waiver of Liability carefully and in its entirety. It is a binding legal document.If you are under the age of 18, this form must be signed by you as the participant AND by your parent or legal guardian.I know that participating in the Race Against Violence 5K or 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 courrse, including, but not limited to, curbs, cars, uneven payment, potholes, rocks, and objects on the course surface. Knowing and appreciating these tisks and in consideration of your acceptance of my entry. I hereby for myself, my heirs, representatives or anyone else claimingin on my behalf, covenant not to sue, and waive, release, and discharge Kingdom Builder's Family Life Center. its volunteers, and sponsors, and anyone else claiming on my behalf of the Race Against violence 5K or Fun from any and all caims 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 Liabilitt 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 to Kingdom Builder's Family Life Center and/or any person or entity authorized by it to use my name, age, date of birth, finish place and finish time in the public domain. I further grant full permissio for Kingdom Builder's Family Life Center 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.read the above waiver and I agree and accept all terms and conditions set forth herein.Emergency Contact Name:_________________________________________ Telephone#___________________________In signing the Acknowledgement of Risk and Waiver Liability I hereby acknowledge and represent: (a) that I have read thisdocument in its entirety, understand it, and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver ofLiability is the entire agreement between the parties hereto and its terms are contractual and not a mere recital.Participant Signature: _______________________________________________Date:_________________________________=======================================================================================================REQUIRED FOR ALL PARTICIPANTS UNDER 18 YEARS OF AGE:PARENT OR GUARDIAN’S AUTHORIZATION FOR MEDICAL CARE AND CONSENT AGREEMENTI certify that I am the parent or legal guardian of the above-named participant in the ACTIVITY. On behalf of myself and myspouse, partner, co-guardian or any other person who claims the participant as a dependent, I have read the above agreement,I understand the contents of this Acknowledgement of Risk and Waiver of Liability, assent to its terms and conditions, and signthis Acknowledgement of Risk and Waiver of Liability of my own free act. I acknowledge that my dependent and I have agreedto the terms and conditions of my dependent’s participation in the ACTIVITY, and I hereby give my consent to participation bymy dependent in the ACTIVITY, and to receive medical treatment determined to be necessary. I further agree to hold harmless,indemnify and defend Kingdom Builder's Family Life Center from and against all claims, demands or suits that my dependent has or may have.Parent or Guardian Signature:_______________________________________ Date: _________________________________
Waiver & Release
Participant's Signature

Clear
Date Signed

MonthDayYear
Date
Parent/Guardian Signature (If participant is below 18 years old)

Clear
Date

MonthDayYear
Date
Upon, receiving your submission you will receive an email with further information regarding check-in time, vendors, and things you will need for this event. Thank you for taking the time out your day to fill this out! If you have any questions you can call us at (719) 247-8190 or email us at info@kbflc.org
Should be Empty:

Participant Information

Emergency Contact Details

The fee includes; a t-shirt, water bottle, race bib, and swag bag.

Payment Methods

Waiver & Release