Emergency Phone Number:
Additional participants? If so, please give their names and ages:
How did you hear about this event? Please list specific school or organization.
In consideration of the foregoing, I, for myself, my heirs, executors and administrators waive and release any and all rights and claims for damages I may have against the Kitsap County Medical Society Foundation (KCMSF) and any and all agents and employees, for claims and damages, demands, actions whatsoever in any manner, as a result of my participation in the KCMSF Family Fun Run. In case of injury, I give my permission for necessary emergency medical treatment by qualified personnel. Photographs and video footage taken of myself as a result of participation in the KCMSF Family Fun Run may be used by KCMSF in its promotion, educational and/or advertising materials.
By typing your name here, you have read the above waiver and agree to abide by its contents (a signed waiver may be required at the event):
Please Type Name
After clicking "Submit," you will be directed to the Paypal payment page. Our late registration fee is $10 per person or $25 for a family of 5 or more.
PLEASE CLICK ONLY ONCE TO PREVENT MULTIPLE REGISTRATIONS AND PAYPAL CHARGES!