6K TAKBO NI JUANA Sign Up Form

6K TAKBO NI JUANA Sign Up Form
Race Date: March 29, 2025
Location: Baywalk, Poblacion, Inopacan, Leyte
Start Time: 5:00 AM
PLEASE NOTE

For GCASH PAYMENTS, pls prepare a screenshot (to be uploaded) before filling out this form.

For CASH PAYMENTS, you may visit our office (MSWD Office) and pay the registration fee after signing up. Please ensure to pay the registration a week before the activity!

THANK YOU!
Participant Information
Full Name*

First NameMiddle NameLast Name
Age*
Gender*
Address*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Details
Contact Person*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Payment Information
Method of Payment*
For GCASH Payment

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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.
Participant Signature

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Participant Information