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Step 1 of 2 - Family Registration |
Head of Family's First Name | Last Name
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Address 1
| Address 2
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City
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State / Province
Use 2 digit code for US and Canada otherwise, leave blank. | Country, if outside of the U.S. and Canada
Leave blank if address is in US or Canada. |
Zip / Postal Code
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Home Phone
Required... please provide your home number. | Other Phone
Optional... provide an alternate phone number. |
Head of Family's Email Address
Your active Email Address... please check for accuracy. |
Head of Family's Date of Birth
Format: YYYY-MM-DD | Sex
M for Male, F for Female. |
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| | | | Apparel Description We're pleased to offer gray unisex t-shirts to pre-registered participants. Register before October 5th to be guaranteed a shirt. | | | | |
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Shirt Selection
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Student Selection
Optional... a registration discount may be calculated for students. Students must provide their ID at participant check-in. If applicable please select your qualification, otherwise leave blank. |
Emergency Contact
Required... please provide a contact name and phone number of someone who is not running in the race as information which we may use in the unlikely event of an emergency.
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Total Number of Participants for Your Family (2 minimum to 8 maximum)
Please calculate and enter the total number of participants for your family... You plus the number of your family members. Example... Let's say your family is made up of you, your spouse, and two children. You + Spouse + 2 = 4 |
Waiver
For and in consideration of the acceptance of my registration to participate in the Barnabas House Monster Dash 5K Race/Walk scheduled for Saturday, October 12, 2013, I hereby waive, release and discharge in advance Oak Forest Methodist Church, UALR, their members, sponsors, officers and all persons acting in concert with them from any an all claims which may hereafter accrue to me or my heirs or to any other person(s) as a result of my participation in this event. I represent that I am in good physical condition and that I have sufficient skill and experience to safely complete any competition, which I choose to participate in. I also understand that my entry fee is nonrefundable. Agree to waiver by checking here.By agreeing to this waiver you submit to the terms and conditions as set forth by this event and certify that you have provided true and accurate information as requested through this registration process. |
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