Star Spangled 5K Color Run/Walk/Bike Registration Form

Star Spangled 5K Color Run/Walk/Bike Registration Form

Complete this form to register for the event and prepare for race day.
Participant Information

The primary registrant (Must Be 18 Years of Age or Older) is responsible for completing this form and accepting the event waiver for themselves and any minor participants listed on this registration.
Participant Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Additional Family Members / Children
Participant 1 Name

First NameMiddle NameLast Name
Participant 1 Date of Birth

MonthDayYear
Date
Participant 2 Name

First NameMiddle NameLast Name
Participant 2 Date of Birth

MonthDayYear
Date
Participant 3 Name

First NameMiddle NameLast Name
Participant 3 Date of Birth

MonthDayYear
Date
Participant 4 Name

First NameMiddle NameLast Name
Participant 4 Date of Birth

MonthDayYear
Date
Waiver and Release of Liability
I understand that participation in the Star Spangled 5K Color Run/Walk/Bike Ride involves physical activity and may involve risks of injury. I voluntarily assume all risks associated with participation and release the Artesia Arts Council, event sponsors, volunteers, staff, and partners from any liability for injury, illness, loss, or damage that may occur as a result of participation in this event.

I grant permission for photographs and video taken during the event to be used by the Artesia Arts Council for promotional, marketing, and archival purposes without compensation.

I certify that I am physically able to participate in this event. If registering any minor participants listed above, I certify that I am the parent or legal guardian and agree to this waiver on their behalf.
Participant Signature
Parent/Guardian Signature (if participant is under 18)
Date

MonthDayYear
Date

My Products

Adult (18+) Registration

$20.00 Quantity

Child Registration

Free Quantity

Total

Credit Card

Should be Empty:

Star Spangled 5K Color Run/Walk/Bike Registration Form

Participant Information

Additional Family Members / Children

Waiver and Release of Liability

My Products

Credit Card