Fun Run Registration Form

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Select Course(s) to Register*

1K5K (14 and up only)Walk (check this box if you are planning on walking the course)

Date of Birth

Date

Are you registering as: Individual / Family (up to 5)

IndividualFamily (up to 5)

How many total family members will participate?

Please list names and ages of family members. Skip this field if registering as an individual.

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Relevant Medical Conditions, Allergies, or Special Needs Volunteers Should Be Aware Of

Physician or Clinic Info (Optional)

Anything Else We Should Know to Keep You Safe?

T-Shirt Size

If you need multiple t-shirts, please list sizes and quantities here. Families paying the $60 registration fee are limited to 5 shirts. Each additional shirt will be $15.

Please read the waiver form on your account before completing registration.

By submitting this form, I acknowledge that participation in the Young Hearts and Hands Foundation Fun Run (1K/5K) in Katy, Texas, involves physical activity that may be strenuous and carries inherent risks, including but not limited to falls, contact with other participants, effects of weather, traffic and course conditions, and other hazards of road and trail use. I understand and voluntarily accept all such risks.

In consideration of being permitted to participate in this event, I, for myself and for my minor child(ren) listed on this registration, and for our heirs, executors, administrators, and assigns, hereby release, waive, and discharge Young Hearts and Hands Foundation, Katy Responds, event sponsors, volunteers, officials, and any affiliated organizations, as well as their officers, directors, employees, and agents, from any and all claims, liabilities, demands, or causes of action arising out of or related to any loss, damage, injury, or death that may be sustained in connection with participation in or travel to or from the Fun Run.

I certify that I and/or my minor child(ren) are physically fit to participate and have not been advised otherwise by a qualified medical professional. I agree to follow all event rules, instructions, and safety guidelines provided by organizers and volunteers on the day of the event.

I authorize event personnel, first aid providers, or medical professionals to provide or obtain emergency medical treatment for me and/or my minor child(ren) if necessary. I understand that I am responsible for any medical costs incurred as a result of such treatment.

I grant permission to Young Hearts and Hands Foundation and its partners to use photographs, video, or other media recordings of me and/or my minor child(ren) taken during the event for promotional, educational, or fundraising purposes, in print or online, without compensation. If I do not want my or my child27s image used, I will notify the organizers in writing before the event.

By checking the box below and providing my name and signature, I affirm that I am at least 18 years old and that I have read and understand this Waiver and Release of Liability. If I am registering a minor, I confirm that I am the parent or legal guardian of the minor participant(s) listed on this form and that I have the legal authority to sign this waiver on their behalf.

I understand that individual participants under the age of 18 must have this form completed and signed by a parent or legal guardian. By signing below, I, the parent or legal guardian of the minor participant(s) named on this form, confirm that I have read and understand the Waiver and Release of Liability, that I consent to my child's/children's participation in the Young Hearts and Hands Foundation Fun Run, and that I agree to all terms of the waiver on their behalf.

I have read and agree to the waiver*

Agree

Signature of adult participant OR parent/legal guardian (if participant is under 18).

Typed Name for E-Signature*

Please confirm your signing status*

Yes - I am the parent/legal guardian and I am signing on their behalfNo - I am 18 or older and signing for myself

Date of Signature*

Date

How will you pay?*

PaypalVenmoDebit or Credit CardApple Pay

Katy Hearts and Hands Fun Run Registration Form

Emergency and Medical Information

T-Shirt Size Selection

Waivers and Permissions

Payment Information