2023 Jack's Abby United Way 5K

2023 Jack's Abby United Way 5K
Saturday October 14, 2023 • 10:00 AM

Participants who make an additional donation during the registration process of $25 or more
will be entered into a raffle for a $200 Amazon Gift Card.

How many people are you registering? *

(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Review your registration".

Race Form

First Name *

Last Name *

Street Address *

City *

State *

Postal Code *

Phone

Email *

Birth Date *

Gender *

Female Male

Please choose your size. Sizes are only guaranteed to those registered by August 26

T-Shirt Size *

Emergency Contact *

Emergency Contact Phone *

Please select which program you would like your entry fee to support

Program to Support *

How did you hear about this event? *

Registration Fee(s)

Registration Type *

Individual Registration - $ 35.00

14 years old and under - $ 30.00

Additional Donation (optional)

Total for this participant

Credit Card

If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page.

Checkout securely. Pay without sharing your financial information.

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Waiver

United Way 5K Run Walk Waiver and Release Form Release of Liability: I, the undersigned, for myself, my heirs, personal representatives and assigns, do release, waive, covenant not to sue and discharge United Way of Tri-County and affiliated persons and entities with this event, from liability from any and all claims resulting in death, personal injury, accidents or illness and property loss arising from but not limited to, participation in this athletic event. I also understand that entry fees are non-refundable. By checking this box, you agree electronically that you have read, understood and agreed to the waiver(s) above. You also are 18 or older, or have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian. By registering a child under 13, your are consenting to the collection of the child's information that you are providing for the purposes of registration.

Yes *

I agree

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