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4D 10K/5K/1-mile walk-virtual participant

Lebanon, PA 17042

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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.

Basic Info

To be able to access / edit your registration.

Additional Information

Format: mm/dd/yyyy
Used for age group calculations
Format: ###-###-####

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Waiver

Waiver: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running including but not limited to: falls, contact with other participants, effects of the weather including high heat and/or humidity, dehydration, traffic, ice and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself, and anyone entitled to act on my behalf, waive and release the City of Lebanon; Lebanon Professional Firefighters, 4D Mission, MDA, Lebanon Rails to Trails, South Lebanon Township, and all sponsors, race directors, their agents, servants and volunteers, their representatives and successors from all claims or liabilities of any kind associated with this event. I grant permission to all of the foregoing to use any photographs, pictures, recordings, and any other record of this event for any legitimate purposes.
In consideration of MUSCULAR DYSTROPHY ASSOCIATION, INC. ("MDA®") permitting (me)(my child , who is under 18) to participate in the above-named event, I hereby, and for (my)(my child's) heirs, executors, administrators, assigns, and all legal guardians, WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS OF ANY NATURE, FOUNDED IN WHOLE OR IN PART UPON ANY TYPE OF NEGLIGENCE, that (I)(my child) may have against MDA, its directors, officers, employees, agents, chapters, assignees, licensees, volunteers and cooperating entities, their representatives, heirs, executors, administrators, successors, and assigns (the “Released Parties”) arising out of or resulting from any and all injuries or damages of any nature, including death, which (I)(my child) may suffer while taking part in the event or any activities connected with the event. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE any or all of the Released Parties in connection with the event. Consent also is hereby given to use (my)(my child's) name, picture, portrait, likeness, writings or biographical information (including, if applicable, neuromuscular disease diagnosis), and audiotape and/or videotape recordings and sound or silent motion pictures of (me)(my child) in any media for editorial, educational, promotional, and advertising purposes, for the solicitation of contributions, and for any other purpose in furtherance of the corporate purposes and
objectives of MDA. By clicking on the box, I certify that I have read this document and fully understand it, and that I am not relying on any statements or representations of any Released Party. This document shall be binding upon me, (my)(my child's) heirs, executors, administrators, assigns, and all legal guardians (of my child).

I HAVE READ AND UNDERSTAND THIS WAIVER.

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This is a service fee for processing your race application.

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