First Name:

                   Age:

            Gender:  Select One Male Female

           Address:   

                   City: 

                 State:

                     Zip:

                Phone: 

                 Email: 

   Date Of Birth: 

Event Category:   Select One 5K Run 2K Walk

Emergency Contact and Number:

                 Shirt:  Select One Small Medium Large XL XXL

Liability Release and Consent Waiver: I recognize that weather, traffic, road conditions, contact with other participants or other conditions may make this run/walk hazardous. I waive any and all claims for myself, my administrator, and my heirs against all officials, sponsors, organization and any and all volunteers connected with the Tulare County Bar Association, Tulare County Parks & Recreation Division or the County of Tulare, the City of Visalia, or CASA for injury, illness which is directly or indirectly a result from my participation in this event. I am in proper physical condition to complete this run/walk and assume all risks associated with my participation. I also attest that I have read and understand all details of this waiver and agree to obey law enforcement officers and abide by any restrictions set. Furthermore, I hereby grant the agents of this event permission to use photographs or any recordings of my participation in this event for any legitimate purpose. I am at least 18 years of age or have had this signed by my parent or guardian if I have not yet reached the age of 18.

              Waiver:  Select Yes

          Signature:   Required For All Participants
(Parent's signature is required if participant is under 18 years of age)
 

 Online Registration Is Now Closed