Course Registration Form

5K WALK/RUN Registration Form

Fill out the form carefully for registration
Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number
Gender*
Pick Your Dates*

May 17, 2025June 7, 2025May 17, 2025 and June 7, 2025
Registration Type (choose one)*
T-Shirt Size (choose one)*
Waiver

I understand that participating in a 5K walk/run involves risk. I agree not to hold Duane Dean, its organizers, or its sponsors liable for any injuries or damages that may occur. I confirm that I am in good physical health and able to participate.
Signature

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Signature Of Youths Parent/Guardian

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Should be Empty:

5K WALK/RUN Registration Form