Select One: ___Adult (ages 13 and up)

Note: Children 5 and under do not need to register but may participate in the race with registered adult.         

Select One:  ___5K Run   ___Fun Walk

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First Name

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Last Name

__Male

__Female

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Address

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City

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State

Zip

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E-Mail (e-mail will be used to communicate some race info.)

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Phone

As of today, are you a SVYMCA member?  __Yes  __No

__ Check here if you need race day babysitting and include an additional $3.00 with your race fee.

I AM AN ADULT OVER 18 YEARS OF AGE AND WISH TO PARTICIPATE IN YMCA ACTIVITIES. In addition, I give my children permission to participate in YMCA activities. I understand that even when every reasonable precaution is taken, accidents can sometimes still happen.  Therefore, in exchange for the YMCA allowing me to participate in YMCA activities, I understand and expressly acknowledge that I release the YMCA and its staff members from all liability for any injury, loss or damage connected in any way whatsoever to my (or my children's) participation in YMCA activities whether on or off the YMCA's premises. I understand that this release includes any claims based on negligence, action or inaction of that YMCA, its staff, directors, members, and guests. I have read and am voluntarily signing this authorization and release.

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