5K Run Registration Form

Cruising For a Cure Breast Cancer 5K Walk/ Run & Car Show

Date: Saturday, October 3, 2026 Time: 9:15 am Venue: James McKnight Park 700 U.S. 287 Frontage Rd. Mansfield, TX 76063 (Registration begins at 8:00 am)
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*
Are you a breast cancer survivor? If so, for how long?
We will have a special ceremony presentation for loved ones lost to breast cancer. Would you like to recognize a special loved one?
In Case of Emergency
Emergency Contact:*

First NameLast Name
Relationship*
Contact Number*
Format: (000) 000-0000.
YesNo
I, First Name Last Name, I am the parent or legal guardian and hereby give my consent for Classic Cars for the Cure to take and use photographs/videos of my child for promotional, educational, or commercial purposes, without compensation, and I under stand these materials will become the property of the organization." Signature
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.

Registration Fees (Register by August 15th to receive the early bird special. After this date, fees will increase by $5). *

Standard Registration (w/ T-Shirt included)

$25.00 QuantitySize

Breast Cancer Survivor Registrant (w/ T-Shirt included)

$20.00 QuantitySize

Team / Group Registration (w/ T-Shirt included)

$20.00 QuantitySize

Kids T-Shirt (Ages 11 & under) (optional)

$10.00 QuantitySize

Donations

Would you like to make a tax- deductible donation to Classic Cars for the Cure to continue to help our efforts with providing care packages and other relative services for cancer patients? Each donation gives you more tickets into our raffle from our generous donors. Thank you.

$5.00

	Quantity	Price
Donation- 1		$5.00
Donation- 2		$10.00
Donation- 3		$25.00
Donation- 4		$50.00
Donation- 5		$75.00
Donation- 6		$100.00

Total

$0.00

Team Name
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Cruising For a Cure Breast Cancer 5K Walk/ Run & Car Show

In Case of Emergency

Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement