Virtual 5K Fundraiser for Emergency Child Care
Please complete the registration form and waiver below.
First name *
Last name *
Date of birth *
Email Address
Phone number *
Virtual 5K Race Bracket *
In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims for damages or injuries that I may have against the Meriden-New Britain-Berlin YMCA and the Meriden Rotary, and volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees.

I know that participating in a 5K is a potentially hazardous activity. I should not enter unless I am medically able to do so and properly trained. I assume all risks associated with participating in this event. I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that a licensed Medical Doctor has verified my physical condition.

I give permission to publish my 5K results, and my photo and any comments if I provide them.
Participant Signature (Please note parent/guardian must sign for any participant younger than 18 years old) *
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