5K Training Group
August 1 – September 26
6:00 PM - 7:00 PM
Veteran’s Park, River Falls Map

After you fill out this registration form, you will be redirected to a payment site. Please note, you are not registered until payment is submitted.

Questions? Contact us at 715-544-7844 or taren@poweredonwell.com.

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Date of Birth *
Emergency Contact Name *
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Emergency Contact Number *
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Waiver *
Waiver: I, the undersigned, am the Participant or the parent/legal guardian of the minor (Participant) whose name appears below. I know that running is a potentially hazardous activity. I know that the Participant should not participate in physical activity unless medically able and properly trained. I agree to abide by any decision of the program director (Director) relative to the Participant's ability to safely complete the risks associated with participating in this event. I waive and release Powered On Well, Bare Wooden Spoon, directors, agents, employees, sponsors, volunteers, their representatives and successors from all claims or liabilities of any kind arising out of the Participant's participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I further authorize and empower the Director to consent to and authorize any medical care or treatment for the Participant that may appear reasonably necessary as a result of emergency, accident or illness of the Participant whether occurring before, during or after the event. In addition, I hereby authorize the Director, if after a reasonable attempt has been made to reach a parent, guardian, or emergency contact to obtain consent, or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment, and hospital care, to be rendered to the Participant under the general or special supervision and on the advice of any physician or surgeon who may treat the Participant, and by any health care professional who may treat the Participant. I agree to pay for any such treatment and to reimburse the Director for all costs and expenses it may incur related to such treatment. I understand in the event programs promoted by Powered On Well does not take place due to natural disaster, pandemic, a severe weather event, acts of war, acts of God or force, that the Participant's registration will not be refunded.I agree that this consent is intended to be as broad and inclusive a release of liability as permitted by applicable law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I hereby warrant and represent that I am 18 years old or older; I have carefully read this consent and agree to its terms and conditions, that before signing this agreement I had the chance to ask questions; and I am aware that by signing this consent, I assume all risks and waive and release certain substantial rights that I and the Participant may have or possess against the Director, Bare Wooden Spoon, and Powered On Well. To the extent permitted by applicable law, I hereby irrevocably and unconditionally waive trial by jury in any legal action or proceeding related to this agreement.
Photo Release *
Photo Release: I hereby grant Powered On Well, Bare Wooden Spoon, representatives, employees, consultants, and those acting with permission or authority of the aforementioned parties, permission to use the Participant's name, image, voice, and identity in any program for promotion of Powered On Well program promotion including written materials, website materials on any Powered On Well publications across the entire worldwide web including but not limited to www.PoweredOnWell.com and its sub domains, Facebook, any other unnamed form of social media, video, audio, or other forms without prior consent or compensation.
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