Blind Run 313 3K Sign Up Form

Blind Run 313 3K Sign Up Form

A Run/Walk for all ages and all abliites to celebrate Blind Awareness Month
Race Date: Sunday October 1st, 2023
Location: Park address [567 - 4999] Chrysler Dr @ Mack Ave Detroit MI 48201

Tolan Playfield MetroLift Address :601 Mack Ave, Detroit, MI 48201 (I-75 Service Dr @ Mack Ave
Start Time: 1:00pm to 3:00pm

Hosted by: Detroit Renaissance Lions Club and Detroit Lions Club
Participant Information

The Blind and Visually Impaired will be match with guides and anyone may join to support the event by running or walking the course. Finishers will receive a token. Please Lions Club Members at your Club Abbreviation to Suffix in your name (DRLC) or (DLC)
Full Name*

First NameLast NameSuffix
Age
Date

MonthDayYear
Date
Are you Blind or Visually Impaired
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Profile Picture

Browse Files

Cancelof
T-Shirt Size

XSSMLXLXXL
Emergency Contact Details
Contact Person

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Payment Information

Registeration fee will pay for the venue/event and contribute to the causes for the Blind and Visually Impaired supported by the sponsoring Lions Clubs - Leader Dogs for the Blind - Penrickton Center for Blind Children etc.... Cash & Checks go to Lions Club members
Method of Payment
Check with Lions Club for Cash or Check
Fees
prevnext( X )
Registration Fee$25.00

Quantity

Registration Fee (Youth 2-18) $15.00

Quantity

Event T-Shirt$10.00

Quantity

Volunteer Guide $ Free

Quantity

Total $0.00
Waiver & Release
Type a question

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.
Participant's Signature

Powered by Jotform SignClear
Date Signed

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

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty:

Blind Run 313 3K Sign Up Form

Participant Information

Emergency Contact Details

Payment Information

Waiver & Release