CROSS COUNTRY 5K REGISTRATION FORM
Date: Sunday 5 April 2026 Run Off Time: 6:30 a.m.
Name
First Name
Last Name
Address/District
Street Address
Street Address Line 2
City
E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
Sex
Please Select
Male
Female
N/A
Age
16 and Under
17 -21
22- 60
61 and over
In Case of Emergency
Emergency Contact:
First Name
Last Name
Relationship
Contact Number
Format: (000) 000-0000.
Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement
In consideration of my participation in the Cross Country Run, I, the undersigned participant, hereby acknowledge and agree to the following:
I am fully aware of the risks involved in participating in a Cross Country Run and voluntarily assume all such risks.
I am physically fit and have no medical conditions that would prevent my participation in the Cross Country Run.
I agree to comply with all rules and regulations of the Cross Country Run.
I release, discharge, and hold harmless the organizers of the Cross Country Run, their officers, directors, employees, volunteers, sponsors, and any other persons or organizations associated with the Cross Country Run from any and all claims, damages, or injuries, including death, that may arise from my participation in the Cross Country Run or as a result of my use of any facilities or equipment provided by the Cross Country Run.
Date
-
Month
-
Day
Year
Date
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