Kids 2 Mile Run Only age 7-13 – Must have adult presentHow many kids are you registering?One $25Two $50Three $751 Kids 5k Price: $25.00 2 Kids 5k Price: $50.00 3 Kids 5k Price: $75.00 processing Price: $3.95 Parent or guardian information* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Child's Name First Last AgeChild's Name First Last AgeChild's Name First Last AgeCoupon Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name I would like to donate the processing $3.95 Yes! Total $0.00 Hold Harmless* I agree to this Hold HarmlessHold Harmless, Waiver of Liability 1. I accept and assume all responsibility for my personal actions and any and all rise of personal injury that occur during, arise out of or result from my participation in the Trifecta Race at 11090 County Road 512, Fellsmere FL. 2. With the above in mind, I fully acknowledge and agree that Trifecta race event, Trinity Fitness, FIT, and the city of Fellsmere nor any officers, directors, volunteers, employees or agents hereinafter defined as “Trifecta” or “Trinity Fitness”, shall not be responsible or liable in any way for any accident or injury to myself, in connection with the Trifecta race. Further, I do hereby agree to indemnify and hold Trifecta and Trinity Fitness harmless against and from any and all liabilities, damages, claims, suits, judgments and associated costs and expenses (including, without limitation, reasonable attorney fees) of whatsoever kind in connection with the workouts. Further, I make this agreement intending it to be binding upon on my heirs, agents, fiduciaries, successors and assigns. I waive, knowing and voluntarily, each and every claim or right of action I have now or may have in the future against Trifecta & Trinity Fitness related to the Trifecta race. 3. I hereby state that I am in good health and have no restrictions relative to exercise or physical activity. If at anytime during the workouts I need emergency medical care and am not able to give express consent because of my physical or mental condition, I authorize emergency medical care decisions to be made on my behalf, and specifically release the Trifecta race and Trinity Fitness, from any and all liability associated with said medical care decisions. 4. I have read carefully, agree to, and intend to be legally bound by all terms of this hold harmless, waiver of liability, and emergency medical care authorization.CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.