First Name:

        Address:

               City:

             State:

                Zip:

            Email:

           Phone:

Age On Race Day:

                    Event:    Select Event 5K Run 5K Walk 5K Run Group Discount 5K Walk Group Discount For group discount select 5k run or walk group discount.

Minimum of 5 for $3 per person group discount (teams, family, businesses, clubs etc.)

Group Name:

In consideration of the application being accepted, I hereby, for myself, my heirs, and executors waive, release and forever discharge any and all rights and claims for damages which I may have here after accrue to me against the organizers and sponsors of the Collins Center 5K, and verify that I am physically fit and have sufficiently trained for the competition of this walk/run. Further, I hereby grant full permission to any and all of foregoing to use my name, photograph, videotapes, motion pictures, recordings, or any other record of this event for legitimate purpose, without compensation or remunerations. I understand that bicycles, skateboards, roller skates or blades, animals and radio head sets are not allowed in the walk/run and I will abide by this guideline. I understand that if the walk/run is canceled due to circumstances beyond the control of the walk/run committee, my entry fee will not be refunded.

Agree With Waiver: Select Yes

     Signature:       Required for all participants (Parents Signature required if under 18)

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