Kaiser Permanente Village Run 5K – Youth Event Entry Form

Register your child/children for a free sponsored youth entry in the Kaiser Permanente Village Run™ 5K.  One parent or guardian may register multiple kids. No credit card required.

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How did you hear about the Village Run 5K Event? *
Required
EVENT DATE: AUGUST 22, 2026
How many kids are you registering?
Multiple choice — Required
 *
Required
Child #1 *
Date of Birth *
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Gender *
Required T-Shirt Size (Included with Entry) *
Required Shoe Size (Included with Entry) *
Child #2
Date of Birth
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DD
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YYYY
Required T-Shirt Size (Included with Entry)
Required Shoe Size (Included with Entry)
Child #3
Date of Birth
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DD
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YYYY
Gender
Clear selection
Required T-Shirt Size (Included with Entry)
Child #4
Date of Birth
MM
/
DD
/
YYYY
Gender
Clear selection
Required T-Shirt Size (Included with Entry)
Required Shoe Size (Included with Entry)
Child #5
Date of Birth
MM
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DD
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YYYY
Gender
Clear selection
Required T-Shirt Size (Included with Entry)
Required Shoe Size (Included with Entry)
Parent/Guardian Full Name *
Parent/Guardian Primary Phone Number *
Parent/Guardian Email Address *
Emergency Contact Name (Other than Parent/Guardian)
Emergency Contact Phone Number
Do any of the youth participant have medical conditions or allergies we should be aware of? *
I have read, understand, and agree to the Kaiser Permanente Village Run™ 5K Participant Waiver & Event Disclosure (CLICK HERE to Read)

I am the parent/legal guardian of the youth participant(s) listed above. 

I understand that participation in a running event involves risk. I confirm the participant(s) are physically able to take part, and I agree to the Village Run™ 5K waiver and event disclosure on their behalf.

Photo/Video Permission

I understand this event may be photographed or recorded, and I give permission for event photos/videos to be used for Village Run™, GivJoi, and event-related promotion.

Text Message Permission

Yes, Village Run™ may text me event updates about this registration. Message and data rates may apply. Reply STOP to opt out.


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Required
Parent/Guardian Typed Signature *
Today’s Date
Date — Required
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This form was created inside of Village Run.