Wilson Cooperative Club 5K & fun run registration
Event Timing: Saturday, October 25th
5K starts @ 9am - $30 through October 10th
Fun run starts @ 11am - $20 through October 10th
$75 family special through October 10th
Event Address: 3 Lake Drive, Wilson, AR 72395
Contact us at (901)240-3391 or amiableredhead@gmail.com
Sign in to Google to save your progress. Learn more
Participant Name *
Age *
Guardian Name (if participant is under 18)
Email *
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
Address *
T-shirt size *
What events will you attend? *
Required
I understand that I will have to pay $$ in advance or upon arrival *
Required

In consideration of the foregoing, I for myself, my heirs, executors, administrators, personal representatives, successors and assigns waive and release any and all rights, claims, and causes of action I have or may have against Wilson Cooperative Club and its affiliates, their agents, employees, officers, directors, volunteer medical support, successors and assigns and all sponsors, their representatives and successors , that may arise as result of my participation in the Wilson Cooperative Club 5K and fun run and any pre and post-race activities. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I realize medical support for this event will consist primarily of volunteer medical personnel prepared to administer first-aid type assistance along the race course and at the finish line. Further, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose, including commercial advertising. 

*
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report