5K Walk / Run Registration Form

Cruising For a Cure Breast Cancer 5K Walk/Run

Date: Saturday, October 3, 2026 Time: 9:00 am Venue: James McKnight Park 700 U.S. 287 Frontage Rd. Mansfield, TX 76063 (Registration begins at 8:00 am)
Name

First NameMiddle NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Contact Number
Format: (000) 000-0000.
Would you like to add another Family member?
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Sex
Age on Event Date
Are you a breast cancer survivor? If so, for how long?
We will have a special ceremony presentation for loved ones lost to breast cancer. Would you like to recognize a special loved one?
In Case of Emergency
Emergency Contact:

First NameLast Name
Relationship
Contact Number
Format: (000) 000-0000.
I, we hereby grant Classic Cars for the Cure permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
I, First Name Last Name, I am the parent or legal guardian and hereby give my consent for Classic Cars for the Cure to take and use photographs/videos of my child for promotional, educational, or commercial purposes, without compensation, and I under stand these materials will become the property of the organization." Signature
Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement
In consideration of my participation in the 5K Walk / Run, I, the undersigned participant(s), hereby acknowledge and agree to the following:

I release, discharge, and hold harmless the organizers of the 5K Walk / Run, their officers, directors, employees, volunteers, sponsors, and any other persons or organizations associated with the 5K Walk / Run from any and all claims, damages, or injuries, including death, that may arise from my participation in the 5K Walk / Run or as a result of my use of any facilities or equipment provided by the 5K Walk / Run.

Registration Fees (Register by August 15th to receive the early bird special. After this date, fees will increase by $5).

Standard Registration (w/ T-Shirt included)

$25.00 QuantitySize

Breast Cancer Survivor Registration (w/ T-Shirt included)

$20.00 QuantitySize

Kids (Ages 11 & Under)

Free

Kids T-Shirt (Ages 11 & under) (optional)

$10.00 QuantityYouth Size

Donations

Would you like to make a tax- deductible donation to Classic Cars for the Cure to continue to help our efforts with providing care packages and other relative services for cancer patients? Each donation gives you more tickets into our raffle from our generous donors. Thank you.

$5.00

	Quantity	Price
Donation- 1		$5.00
Donation- 2		$10.00
Donation- 3		$25.00
Donation- 4		$50.00
Donation- 5		$75.00
Donation- 6		$100.00

Enter coupon

Total

Team Name (If Applicable)

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Date

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Date
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Cruising For a Cure Breast Cancer 5K Walk/Run

In Case of Emergency

Release and Waiver of Liability - Assumption of Risk and Indemnity Agreement

Registration Fees (Register by August 15th to receive the early bird special. After this date, fees will increase by $5). *

Payment Methods

Registration Fees (Register by August 15th to receive the early bird special. After this date, fees will increase by $5).