Participant Information
Full Name
First Name
Last Name
Age
Date
-
Month
-
Day
Year
Date
Gender
Please Select
M
F
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Emergency Contact Details
Contact Person
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relationship
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 event
I acknowledge that this run requires physical activity; I assume all possible associated risks and danger.
I release the event organizers, Dell Rapids Chamber of Commerce, and city of Dell Rapids against any and all liability, claims, judgements, or demands, including demands arising from injuries, accidents, illness, or death of persons arising directly or indirectly to the event.
I confirm that all information in this registration form is accurate and true.
Participant's Signature
Date Signed
-
Month
-
Day
Year
Date
Parent/Guardian Signature (If participant is below 18 years old)
Date
-
Month
-
Day
Year
Date
Submit
Print Form
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