Registration On Site - Fun Bun Run

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Participant Type *

Competitive Runner - $25
Fun Runner/Walker - $25

Gender *

Male
Female

T-shirt size (Adult Sizes) *

Date of Birth *//

Used to determine runner/walker age category

Children 12 and Under

Children 12 and under are free - Do you want to register any?

Yes
No

Child 1 Name

First

Last

Child 1 - Gender

Male
Female

Child 1 - T-shirt size

Small
Medium
Child Large/Adult Small
Adult Medium

Child 1 - Date of Birth//

Used to determine runner/walker age category

Do you want to register a 2nd Child?

Yes
No

Child 2 - Name

First

Last

Child 2 - Gender

Male
Female

Child 2 - T-shirt size

Small
Medium
Child Large/Adult Small
Adult Medium

Child 2 - Date of Birth//

Used to determine runner/walker age category

Do you want to register additional children?

Yes
No

Information for additional children

Please provide NAME, DATE OF BIRTH, GENDER and T-SHIRT SIZE for any additional children 12 and under participating with in in this event

WAIVER AND RELEASE I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I KNOW THAT THIS EVENT IS A POTENTIALLY HAZARDOUS ACTIVITY AND I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY INJURY OR ACCIDENT WHICH MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT OR WHILE ON THE PREMISES OF THIS EVENT, AND I HEREBY RELEASE AND HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST HOPE FOR HAITIANS, THE TIMING COMPANY, AND ANY AFFILIATED INDIVIDUALS, AND WALK/RUN SPONSORS AND THEIR AGENTS AND EMPLOYEES, AND ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THIS EVENT (THE “RELEASEES”) FROM ANY LOSS, LIABILITY, DAMAGE, OR CLAIMS I MAY HAVE ARISING OUT OF MY PARTICIPATION IN THIS EVENT, INCLUDING PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS, WHETHER SAME MAY BE CAUSED BY FALLS, CONTACT WITH OTHER PARTICIPANTS, CONDITIONS OF THE COURSE, NEGLIGENCE OF THE RELEASEES OR OTHERWISE. If I do not follow the rules of the event, I understand that I may be removed from the event. I give my full permission to Hope for Haitians, the timing company and their sponsors to use any photographs, videotapes, or other recordings of me that are made during the course of this event.

Waiver and Consent Form Acceptance *

I accept the conditions of the Waiver and Consent Form

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

Registration - On Site Participants

Children 12 and Under