Kukini 2020

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Team name   First name   Last name   Email address   Age on event date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Gender -- Male Female   Phone #   Address   Emergency contact name   Emergency phone #   Select 5k / 8k / Fun Run Choose one Fun Run 5k 8k   Age Group Choose one Female 0-19 Female 20-29 Female 30-39 Female 40-49 Female 50-59 Female 60-69 Female 70-79 Female 80-99 Male 0-19 Male 20-29 Male 30-39 Male 40-49 Male 50-59 Male 60-69 Male 70-79 Male 80-99 Choose one Female 0-19 Female 20-29 Female 30-39 Female 40-49 Female 50-59 Female 60-69 Female 70-79 Female 80-99 Male 0-19 Male 20-29 Male 30-39 Male 40-49 Male 50-59 Male 60-69 Male 70-79 Male 80-99 Choose one Female 0-19 Female 20-29 Female 30-39 Female 40-49 Female 50-59 Female 60-69 Female 70-79 Female 80-99 Male 0-19 Male 20-29 Male 30-39 Male 40-49 Male 50-59 Male 60-69 Male 70-79 Male 80-99   Event entry fee TBD

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver Waiver of Liability Participant understands that he/she is subject to the school and council rules of conduct and sportsmanship. The undersigned acknowledges that neither the Virginia Tidewater Trailrunners LLC, Gwynn’s Island Civic League, Gwynn’s Island RV & Campground, nor the Mathews County YMCA provide any registrant medical or hospitalization insurance whatsoever, and hereby waives any and all claims against the Virginia Tidewater Trailrunners LLC, Gwynn’s Island Civic League, Gwynn’s Island RV & Campground, the Mathews County YMCA, or any other person affiliated with these entities and sponsors for injuries sustained while watching or participating in this event or traveling to and from event. I also agree that photographs taken of my child or me while participating in this activity may be used for publicity. I accept the terms of the waiver Name of parent or guardian who approves this activity Please enter your name here