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
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

MonthDayYear
Date
Signature

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Registration Fee: $20.00

Please remit payment by April 20th, 2026
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
Should be Empty:

BAREFOOT HOPE 5K RUN/Walk REGISTRATION FORM