Fillmore 5K

Who are you registering? Choose one Yourself

Team name   First name   Last name   Email address   Date of birth    MM 01 02 03 04 05 06 07 08 09 10 11 12    DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    YYYY 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925    Gender -- Male Female Non-Binary   Hometown Other   -- AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT   Phone #   Emergency contact name   Emergency phone #   City   Category Choose one 10 and under 11-14 15-18 19-29 30-39 40-49 50-59 60-69 70 and up   Event entry fee TBD

Are you an FLRC member in good standing? NoYes -5.00 USD Where did you learn about this race? Choose one... From a Friend FLRC Forum Post FLRC Website FLRC Facebook Post FLRC Postcard Calendar Bulletin Board Poster Media Coverage Other Website/Race Calendar Other I'd like to donate to FLRC's philanthropic efforts supporting running in our community. NoYes USD

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver I know that running a road race is a potentially hazardous activity. I should not enter and run the Fillmore 5K unless I am medically able and have trained properly. I agree to abide by any decision of a race official as to my ability to safely complete the event. I assume all risks associated with running in this event, including, but not limited to, contact with runners, falls, the effects of the weather including humidity and temperature, road conditions including traffic and the actions of motorists and adjoining landowners whether unintentional or intentional, and 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 all sponsoring and affiliated parties including the FLRC officers, race directors and volunteers, Village and Town of Moravia, Moravia CSD, Four Town First Aid Squad, Inc. and their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I further grant permission to all of the foregoing to use any photographs, motion pictures, recordings or other record of this event for any legitimate purpose. I also understand that all entry fees are non-refundable. If participant is under 18, agreeing to this waiver indicates that the parent or guardian has approved this activity. In addition to the foregoing, I agree to abide by all of FLRC’s instructions aimed at preventing the spread of COVID-19. I understand that, even with these instructions in place, there remains a risk that I could contract COVID-19 while participating in this race. I further understand that contracting COVID-19 may lead to serious illness or death. I voluntarily assume these risks, and I hereby release and discharge all of the entities and persons named above from all claims or liabilities relating to any injury or loss connected to COVID-19 or any other illness that I may contract during this race. I accept the terms of the waiver Name of parent or guardian who approves this activity