5K WALK/RUN REGISTRATION

5K WALK/RUN REGISTRATION
Community-Based Violence Intervention Prevention Program
Each participant must register

.
May 17, 2025June 7, 2025
Name

First NameLast Name
AGE
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
MALEFEMALE
RunnerWalker
Adult (M)Adult (L)Adult (XL)Adult (XXL)
Waiver:

I understand that participating in a 5K walk/run involves risk. I agree not to hold the Duane Dean Community-Based Violence Intervention Prevention Program, its organizers, or sponsors liable for any injuries or damage that may occur. I confirm that I am in good physical health and able to participate in this 5 K walk/run.
Participate Signature

Powered by Jotform SignClear
Signature of Youth's Parent/Guardian

Powered by Jotform SignClear
Should be Empty:

Community-Based Violence Intervention Prevention Program