5K Run/Walk & Breakfast Registration Form

Thank you for supporting youth health & wellness programs at Berkshire South Regional Community Center by participating in our annual 5k Run/Walk & Breakfast. Registration is $25 per participant up until 5 p.m. on April 7, 2017; $30 per participant thereafter; Same day registration is accepted at the Housy Dome beginning at 8:00 a.m. A registration form will be required for each entry. Those age 7 and under are free alongside registered parent/guardian.

The first 135 paid registered participants will receive an exclusive race t-shirt. Sizes cannot be guaranteed.

Instructions: Please enter all the information requested below, type your name where indicated for signature, read the refund policies and release, and clicks on the "Submit" button at the bottom to send your registration. On-line registrations are subject to verification.

Section I — Personal Information:

 
 
 
Gender:     
 
 
 
 
 
 
       
    
Are you a member?    
            

Section II — Program Information:

Enter the Program Information for verification:
Race Date: 04/09/17 Program Title: 5k Run/Walk Fee: $25 up until noon 04/07/17 ($30 Race Day Registration). If registering for a child age 7 or under, please enter 0 for fee.

 
 
 

Section III — Breakfast Reservation:

All race participants are invited back to Berkshire South Regional Community Center for a Breakfast and award ceremony immediately following the race. Complimentary for all participants, guest tickets are $2/child and $4/adult. Breakfast served 10 a.m. until 12 p.m.

 
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 $
 

Section IV — Payment Information:

     
     
 

Refund Policies:

In the event that you are unable to attend your 5 k Run/Walk & Breakfast registration will be considered a donation. Your registration is nonrefundable.

Release of all claims & promise not to sue:

As a participant in this and any other program of the Berkshire South Regional Community Center, I recognize and acknowledge that there are certain risks and I agree to assume all such risks, including any damage resulting from physical injuries, loss of services or consortium, loss or damage to property, or any other loss I may sustain as a result of participating in any and all activities connected with or associated with such programs.

In consideration of the Berkshire South Regional Community Center accepting my or my child’s registration, and with the intent to be legally bound, hereby, for myself, for my child, all heirs, executors, administrators, and assigns, do hereby forever release, waive and relinquish all claims I have or may have as a result of participating in this and all other programs of the Berkshire South Regional Community Center. Furthermore, I promise not to sue the Berkshire South Regional Community Center and agree to indemnify and hold harmless and defend the Berkshire South Regional Community Center and its officers, agents, servants, employees and insurers from any and all liabilities, claims, demands, actions or causes of action resulting from my or my child’s participation in this or any other programs of the Berkshire South Regional Community Center.

By signing this form, I hereby acknowledge that all information contained herein is true and correct and that I may give up legal rights.

  (or parent or guardian if participant is under the age of 18)