Name *

First Name

Last Name

Age Range *

0-12 years

12-19 years

20-29 years

30-39 years

40-49 years

50-59 years

60-69 years

70+ years

Participation Type *

How do you intend to participate in the 5K?

I plan to attend the 5K in person on October 15

I plan to run or walk a 5k at some other time (virtual participants not eligible for fastest time prizes)

I just want to support PSSWF (and get a t-shirt and be in the running for cool prizes), I don't plan to run or walk a 5K

Payment *

Registration Fees: Adult: $20 Children 15 and up: $15 Children 10-14: $10 Children under 10: $5 Carry-along babies/strollers: Free Registration fee must be RECEIVED by Saturday, October 15th at 9:00am. How will you be paying your registration fee?

Mail Check to PSSWF 5945 County Road 346, Silt CO 81652 (Please note that check is for race registration)

PayPal Donation via psswf.org/donate (if credit card/donation name is different than registrant name, please let us know!)

Agreement and Release of Liability *

In consideration for being permitted to participate in the "Run/Walk for Their Lives" Virtual 5K Race, I hereby agree as follows: 1. I hereby release and discharge all parties (collectively referred to as "Released Parties") from any and all liability, claims, demands, or causes of action that I may hereafter have for injuries or damages arising out of my participation in the Run/Walk for Their Lives 5K Virtual Race, including but not limited to, losses caused by the negligence of the Released Parties. 2. I further agree that I will not sue or make a claim against the Released Parties for damages or other losses sustained as a result of my participation in the Run/Walk for Their Lives Virtual 5K Race. I also agree to indemnify and hold the Released Parties harmless from all claims, judgements, and costs, including attorney's fees, incurred in connection with any action brought as a result of my participation in the Run/Walk for Their Lives Virtual 5K Race. This includes any claim for indemnity or contribution against the Released Parties.

I have read this agreement and release of liability, fully understand it, and agree to its terms.