5K REGISTRATION FORM
In order to participate in the event please fill out the form below.
Name
First Name
Last Name
Date of Birth
Name and DOB of additional participants.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
In Case of Emergency
Emergency Contact:
First Name
Last 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 , I, the undersigned participant, hereby acknowledge and agree to the following:
I am fully aware of the risks involved in participating in a 5K and voluntarily assume all such risks.
I am physically fit and have no medical conditions that would prevent my participation in the 5K.
I agree to comply with all rules and regulations of the 5K.
I release, discharge, and hold harmless the organizers of the 5K, their officers, directors, employees, volunteers, sponsors, and any other persons or organizations associated with the 5K from any and all claims, damages, or injuries, including death, that may arise from my participation in the 5K or as a result of my use of any facilities or equipment provided by the 5K.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit Form
Submit Form
Should be Empty: