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2. 
3. Event*

   1. 5K
   2. Family Fun Run

   Will you be joining us for the 5K route (beginning at 9:00am) or the Family Fun route (beginning at 9:30am)

   Note: Go your own pace!  This is a FUN time so feel free to either challenge yourself, or enjoy the path with your friends and/or family!  The runs will kickoff at the times above, but you may join them at anytime before 9:40am!

   5K Route - ~3.1 Miles
   Family Fun Route - ~1.68 Miles

5. How many people will be in your group?*
7. First Name*
8. Last Name*
10. Address*
11. City, State Zip code*
13. Phone*
14. Email address*
16. Emergency Contact*
17. Emergency Contact Phone Number*
21. Electronic Signature Agreement*

    WAIVER STATEMENT: The undersigned states that he/she understands that the Johnson County Park & Recreation District is not and shall not be responsible for or liable for any illness, injury, or death to person or damage to property, including but not limited to illness, injury, or death arising from exposure to the Novel Coronavirus (COVID-19), resulting from the program in which the undersigned is enrolling or being enrolled or from his/her participating in said program, and the participant and the undersigned, if the participant is a minor or under other legal disability, hereby forever releases and holds harmless the said Johnson County Park & Recreation District, it's employees, agents and representatives from any and all claims of any kind, including but not limited to claims arising from exposure to the Novel Coronavirus (COVID-19), that the participant, or the undersigned or their respective heirs, executors, administrators, or assigns may have or claim to have resulting from participation in said program. NOTICE: By enrolling in this program you hereby acknowledge the Johnson County Park & Recreation District can and may photograph and/or video tape program participants and then use such images without payment or any other consideration, for purposes of publicizing District parks, facilities, programs or services, or for any other lawful purpose.

    1. I agree.
23. Electronic Signature (Parent signature if participant is under the age of 18)*
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

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