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After form submission, please send payment as instructed on the following page.
First Name
Last Name
Email Address
Home Phone
Zip Code
Shirt Size
Waiver Statement:
I attest and verify that, the undersigned, intending to be legally bound, hereby, for myself, and my heirs, successors, and assignees, release any and all claims for losses and damages, attorney fees, court cost and cost of collection which I or the above named entrant may now or in the future have against "Katie's Hope/Katie's 5K Run/Walk" and any groups associated with this event.
Electronic Signature (enter name)
Date  (mm/dd/yyyy)
Signature of Participant or Guardian if Participant is under 18 years of age