Pirate 5K Booty Run Online Registration

Ages	Fee
1 - 9	$25.00

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Registrant #1

Who are you registering? *

Myself 18+

Friend 18+

Minor Under 18

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

First Name *

Last Name *

E-mail Address *

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Additional Information

Date of Birth *

Format: mm/dd/yyyy

Used for age group calculations

Gender * Male Female

Phone *

Format: ###-###-####

Address

Street Address *

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City *

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Choose Your Event(s) *

$30.00 Event Fee Special Pricing (Group Pricing) $40.00 Event Fee (Group Pricing)

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Waiver

In consideration of you accepting this entry, I, the participant, intending to be legally bound and hereby waive or release any and all right and claims for damages or injuries that I may have against the Event Director, RunSignup.com, and all of their agents assisting with the event, sponsors and their representatives and employees for any and all injuries to me or my personal property. 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 also authorize the use of photographs or videos that include my image for promotional, informational, or other reasons deemed to be in the best interest of the event.

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 my physical condition has been verified by a licensed Medical Doctor. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above waiver.

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By checking this box, I agree to the waiver and that I am 18 or older, or that I have the authority to register these participants and agree to the waiver for them, and agree to the Privacy Policy.

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