Register For
Mind & Body Connection 5K

West Palm Beach, FL 33401

Registrant #1

Who are you registering? *


By selecting this box, you are indicating that you are the parent/guardian of the person you are about to register. Additionally, if the child is under the age of 13, you are consenting to the collection and use of the information about the child for the purpose of the registration as described in our privacy policy.

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Basic Info

To be able to access / edit your registration.

Additional Information

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Used for age group calculations
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$45.00 + $3.61 SignUp Fee

$45.00 + $3.61 SignUp Fee

Waiver

ONLINE REGISTRATION RELEASE AND WAIVER 

In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all right and claims that I may have against K2 Road Sports, its employees, race director, volunteers, City of West Palm Beach, Mental Health America of the Palm Beaches, K2 Sports Ventures, RunSignup.com, Accuchip Timing, and any and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees, as well as the officers, trustees, directors, agents, volunteers and employees of any of the preceding entities, in addition to all sponsors, their representatives and successors and all of their agents assisting with the event (hereinafter referred to as “Releasees”), for any and all liability, claims, demands, actions and causes of action arising out of or related to any loss, damage, injury , including death, to me, my child , or my personal property by participating in the road race and associated events. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees.
I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able to do so and properly trained. I acknowledge that I am in good physical condition to participate in the road race. I assume all risks associated with running in this event including, but not limited to: falls, injury, death, contact with other participants, the effects of weather, traffic, and course conditions, and waive any and all claims or cause of action which I might have based on any of those and other risks typically found in running a road race and voluntarily release, waive, discharge, covenant not to sue and hold harmless the Releasees. I acknowledge all such risks are known and understood by me. I agree to abide by all decisions of any race official relative to my ability to safely complete the run. I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that a licensed Medical Doctor has verified my physical condition.
In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization.
By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) have read and agreed to the above release and waiver in favor of the Releasees for myself, or my minor child, as the case may be.
Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications, or any other print, videographic or electronic medium of this event for legitimate purposes and without compensation to me or my child

Refund Policy. I acknowledge that my entry fee is non-refundable, including if the race is cancelled, and my entry is non-transferable. Further, I agree that I will not file a chargeback for the registration fee.

Stroller Policy: Strollers are not allowed.
Dog Policy: Dogs are not allowed. 
Bib Policy: Only registered participants wearing the official race bib are allowed on the course.


STATUTORY NOTICE TO MINOR CHILD’S PARENT/NATURAL GUARDIAN


READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN POTENTIALLY A DANGEROUS ACTIVITY/PROGRAM/ROAD RACE. YOU ARE AGREEING THAT, EVEN IF THE REALEASEES AND/OR ITS OFFICERS, TRUSTEES, DIRECTORS, EMPLOYEES, VOLUNTEERS AND/OR AGENTS USES REASONABLE CARE IN PROVIDING THIS ACTIVITY/PROGRAM/ROAD RACE, THERE IS A CHANCE YOU OR YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY/PROGRAM/ROAD RACE BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY/PROGRAM/ROAD RACE WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM THE RELEASEES OR ITS OFFICERS, TRUSTEES, DIRECTORS, EMPLOYEES, VOLUNTEERS AND/OR AGENTS, IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOU, YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY/PROGRAM/ROAD RACE. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM AND RELEASEES, OR ITS OFFICERS, TRUSTEES, DIRECTORS, EMPLOYEES, VOLUNTEERS AND/OR AGENTS, HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

 




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