Online Registration

4th Annual Child Advocacy Center 5K Race & Fun Walk
Saturday April 20, 2013
Eastern Mennonite University

Online Registration Is Now Closed

 

      

Proceeds Benefit
The Child Advocacy Center of Harrisonburg & Rockingham County

Schedule of Events
8:00 amRegistration
9:15 amPre-Race Instructions
9:30 am5K Run Start
9:35 am5K Fun Walk Start

♦ Register by April 5th to receive a t-shirt
♦ Awards for top three finishers in each male and female age division
♦ Refreshments provided post-race
♦ Groups and teams are welcome Minimum of 5 participants per team
$3 discount per team member

Registration Fees
Prior to April 5th$20
After April 5th & Event Day$25

Collins Center & Child Advocacy Center www.thecollinscenter.org/volunteer/5k

Mail In Registration Form

   
  

Please Enter Participants Information and click below to proceed to a secure credit card processing page. To register more than one participant select the "Add Additional Registration" option after submitting each registration or just click on the "Back Button" in Your Browser to return to this page.

Please notify garydsmith@runwalkjog.com if you experience problems with online registration.  For online registration a processing fee of $2.00 will be added to the registration fee.

   
4th Annual Child Advocacy Center 5K
 
   Last Name:


   First Name:


        Address:


               City:


             State:


                Zip:


            Email:


           Phone:


Age On Race Day:

              Shirt Size:  

                    Event:  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:


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



Click below to proceed to a secure credit card processing page.  To register more than one participant select the "Add Additional Registration" option after submitting each registration or just click on the "Back Button" in Your Browser to return to this page.

Online Registration Is Now Closed

 
   
Online Payments
   
          
   

Acceptance Mark
 

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