JSK 5K Walk 2024

5K Health Walk, Fair, and Fun

Jaswant Singh Khalra Park
Date: November 16, 2024
Time: 7:30AM
Location: Jaswant Singh Khalra Park, 3861 W Clinton Fresno, CA 93722

We are excited to have you join our second 5K Walk "Sair for Sehat"!
Please complete the form and $5 entry fee below to secure your spot and registration packet.

Registration fee includes the T-shirt we encourage you to wear at the 5K walk and other items we wish for you to remember the event by.

Your T-shirt will be given on November 16th before the 5K walk. Please arrive by 7:30am - DO NOT BE LATE.

*Each participant can register up to 5 family members per form
(Please fill out form again for remaining persons)

For questions regarding the 5K Walk prior to the event
Contact Nanaki at 559-978-4070 or email at nanaki@jakara.org
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birthdate*

MonthDayYear
Age
Current

MonthDayYear
Gender*

MaleFemaleNon-binaryPrefer not to sayOther
Your Shirt Size*
Are you registering any family members with you?*
(If more than 5 people, please fill out another form with remaining persons)
Person 1 Name*

First NameLast Name
Person 1 Birthdate*

MonthDayYear
Date
Person 1 Shirt Size*
Person 2 Name*

First NameLast Name
Person 2 Birthdate*

MonthDayYear
Date
Person 2 Shirt Size*
Person 3 Name*

First NameLast Name
Person 3 Birthdate*

MonthDayYear
Date
Person 3 Shirt Size*
Person 4 Name*

First NameLast Name
Person 4 Birthdate*

MonthDayYear
Date
Person 4 Shirt Size*
Person 5 Name*

First NameLast Name
Person 5 Birthdate*

MonthDayYear
Date
Person 5 Shirt Size*
Please list any health concerns for all persons above (i.e. history of Asthma) - Enter "none" if no concern.
How did you learn about this event?*

Jakara Staff MemberJakara InstagramJakara NewsletterPunjabi RadioFlyer sent to my homeOther
I will arrive by 7:30 AM on the morning of the event, November 16th, at Jaswant Singh Khalra Park*

I will arrive by 7:30 am.
Liability Waiver & Media Release

To the best of my knowledge, I am in good condition and fully able to participate in the 5K Health Walk "Sair for Sehat". I am fully aware of the risks and hazards connected with the participation in this 5K Walk, including injury, and herby announce my participation in this event, knowing that the associated physical activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY HEALTH RISK OR PERSONAL INJURY, that may be sustained by me as a result of participation in this event.

I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Jakara Movement, their volunteers, or employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where events are being conducted.

In signing this release, I acknowledge and represent that I HAVE READ THE FORGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.

Jakara often uses pictures and videos of participants to recognize their great participation, apply for grants, and to encourage other participants to attend. All pictures are screened for appropriateness. We appreciate your support!

I, the undersigned, do hereby grant permission to the Jakara Organization to use my image. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of myself for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Jakara Organization’s website.
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How would you like to pay the registration fee?*

I will pay the registration fee electronically.I will pay in person on the day of the event.I handed cash payment to a staff member prior to completing this form.
Which Jakara Staff member did you give the cash payment to?*
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5K Health Walk, Fair, and Fun