Run/Walk Registration Form

Run/Walk Registration Form
Run/Walk Date: July 11, 2026
Location:Westbrook Park, DeWitt, IA 52742
Start Time: 7:00 - 11:00 AM
Participant Information
Full Name*

First NameLast Name
Age*
Email*
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details
Contact Person*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship
Waiver & Release
I confirm that I am in good shape, health and condition to participate in the Miles of Meaning event.
I don't have any medical condition or medical history that will affect my ability to participate in this event.
I acknowledge that this run/walk requires physical activity and there are possible risks and dangers associated with participating.
I release the Miles of Meaning 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's Signature*

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Date Signed*

MonthDayYear
Date
Parent/Guardian Signature (If participant is below 18 years old)*

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Date*

MonthDayYear
Date
I would like to remain anonymous and not have my name posted on the event website as a participant.
Should be Empty:

Participant Information