5K Registration

5K Registration

Girls on the Run Palm Beach

Inspiring girls to be joyful, healthy, and confident.

$30 pp Registration fee

NOTE: Bibs will NOT be chip-timed.

GOTR Participants are NOT eligible for timed race awards.

1st Registration: Name*

First NameLast Name

Birth Date*

T-shirt size (size not guaranteed)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Relationship to GOTR girl*

e.g. sister, brother, neighbor, classmate, etc.

GOTR girl's school or site. If none, type NA*

You can register up to 4 people

living at the same address in one form.

PLEASE fill in ALL of the information for each registrant.

Please use a new form for a different address.

2nd registration Name

First NameLast Name

2. Gender

2. Birth Date

2. T-shirt size (size not guaranteed)

2. Relationship to GOTR girl

3rd Registration Name

First NameLast Name

3. Gender

3. Birth Date

3. T-shirt size (size not guaranteed)

3. Relationship to GOTR girl

4th Registration Name

First NameLast Name

4. Gender

4. Birth Date

4. T-shirt size (size not guaranteed)

4. Relationship to GOTR girl

Check boxes for Total Amount to be paid*

1st Registration$30.00

2nd Registration - add$30.00

3rd Registration - add$30.00

4th Registration - add $30.00

Add my donation of$5.00

Add my donation of$10.00

Add my donation of$25.00

Add my donation of$50.00

Add my donation of$100.00

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Email*

Phone Number*

Area CodePhone Number

Relationship to GOTR*

POLICIES:

1. GOTR girls and their Running Buddies do NOT need to pay to be part of the Council-organized 5K event. If you pay for them here in error, there will be no refunds.

2. If payment is made for fewer registrations than names and information are entered, we will only register those individuals that have been paid for, in the order they appear in this form.

3. All registrations are non-transferable.

4. NO bibs are timed for these registrations.

I understand that by registering through the Girls on the Run website, my bibs are not timed and are NOT eligible for any of the timed 5K awards associated with this event.

5. There are no refunds for any reason at all.

WAIVER:

In consideration of my participation in the 5K ("the run") as well as any family members I have registered with this form, I hereby for myself, my family, my heirs, and my personal representatives, assume any and all risks which might be associated with the event, and I further waive, release, discharge and covenant not to sue Girls on the Run Palm Beach, Girls on the Run International, Accuchip USA Inc., any and all organizers or other representatives, sponsors or anyone affiliated with the Run or successors and assigns, for any injuries or damages of any kind whatsoever as a result in taking part in the events and related activities.

I hereby grant full permission to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose, including commercial advertising without monetary payment to me.

CERTIFICATION

I certifiy that if I am registering a minor, I am the parent or legal guardian of the minor.

When you type your name below and

click "Finish 5K Registration" below

you agree to these policies, waiver and certification.

There are no refunds for any reason.

Name of person submitting the 5K registration(s):*

First NameLast Name