HERMANN STUCO COLOR RUN - 5K REGISTRATION FORM
Date: May 3, 2023 Time: Check-in Starts at 7:00AM, Race at 8:00AM Location: 176 Bearcat Xing, Hermann, MO 65041 Bring a Towel for Clean-Off After
Name
*
First Name
Middle Name
Last Name
E-mail
*
example@example.com
Contact Number
*
Age
*
T-Shirt Size
*
Adult Extra Small
Adult Small
Adult Medium
Adult Large
Adult Extra Large
REGISTRATION (T-SHIRT INCLUDED) - PAY IN PERSON WITH CASH OR CHECK
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VETERAN
$
20.00
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ADULT
$
35.00
Quantity
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YOUTH (14 & UNDER)
$
25.00
Quantity
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CHILD (5 & UNDER)
$
Free
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In Case of Emergency
Emergency Contact:
*
First Name
Last Name
Contact Number
*
Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement
In consideration of my participation in the 5K Run, I, the undersigned participant, hereby acknowledge and agree to the following:
*
I am fully aware of the risks involved in participating in a 5K Run and voluntarily assume all such risks.
I am physically fit and have no medical conditions that would prevent my participation in the 5K Run.
I agree to comply with all rules and regulations of the 5K Run.
I release, discharge, and hold harmless the organizers of the 5K Run, their officers, directors, employees, volunteers, sponsors, and any other persons or organizations associated with the 5K Run from any and all claims, damages, or injuries, including death, that may arise from my participation in the 5K Run or as a result of my use of any facilities or equipment provided by the 5K Run.
Date
*
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Month
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Day
Year
Date
Signature
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