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5K Walk and Family Fun Day Registration Form
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Participant Name
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Parent/Guardian Name if Under 18:
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First
Last
DOB required if under 18 (mm/dd/yy)
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Gender
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Email
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Phone Number
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Church Affiliation
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St. Mary - Raleigh, NC
St. Mark, Charlotte, NC
Archangel Raphael & St. John - Chapel Hill, NC
Archangel Michael & St. Philopateer - Winston Salem, NC
St. George - Fayetteville, NC
St. Mary, Greer - SC
Archangel Michael - Greenville, SC
St. Mark - Myrtle Beach, SC
St. Mary & St. Mina - Fort Mill, SC
St. Mark - Louisville, KY
St. Shenouda & St. Abram - Auburn, KY
Holy Virgin Mary & St. Philopateer - Lexington, KY
Other Church.. please specify ==>
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Waiver of Liability (Check box for consent):
In consideration of my entry being accepted and by signing below, I waive any and all claims for myself, my administrators, and my heirs against all officials, sponsors, and organizations connected with the Walk for injury or illness that may directly or indirectly result from my participation in this event. I attest that I have full knowledge of the risks involved in this event, and am physically fit and sufficiently trained to participate in this event. Furthermore, I hereby grant full permission to take and use any photographs taken during the event race in which I may appear for any legitimate reason that may include future advertising and promotion.
By registering, you agree to pay the $35 entry fee. Your registration is incomplete until you complete your payment.
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