Barefoot Hope 5k Run/Walk Registration Form

BAREFOOT HOPE 5K RUN/Walk REGISTRATION FORM

Date: May 3, 2026 Time: 8am-12p Venue: Piermont Pier, Piermont, NY
Name

First NameMiddle NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
Sex
Age on Event Date
In Case of Emergency
Emergency Contact:

First NameLast Name
Relationship
Contact Number
Format: (000) 000-0000.
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:
Date

MonthDayYear
Date
Signature
Registration Fee: $20.00

Please remit payment by April 20th, 2026
Donation Amount

prevnext( X )
USDDescription
You can also pay by check. Checks must be received by 4/20/26.

Makes checks payable to:

Barefoot Hope Inc.

7 Legends Blvd

West Nyack, NY 10994

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

BAREFOOT HOPE 5K RUN/Walk REGISTRATION FORM