Paper Option: Download this printable registration form.

First Name:

Last Name:

Email:

Address:

City:

State: -- Select a State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Phone:

What are you registering to do? -- Select one -- Walk Run Volunteer

T-shirt size (adult sizes) -- Select one -- S M L XL XXL

Age [ on 11/08/08 ]:

Additional Comments:

You must agree to the Release and Hold Harmless
Agreement below, please fill in your name to
accept the terms.

Release and Hold Harmless Agreement

I, ,
In consideration of the National Park Service’s permission to access and participate in the Healthy Parks – Healthy Living 5-K Fun Run/Walk (event), do hereby voluntarily and knowingly execute this Release and Hold Harmless Agreement.
 
1. I release and hold harmless the United States Government* from claims, demands, actions, liabilities and judgments for person injuries to property of whatever nature caused by or arising out of my participation in this event.
2. I agree that I will never prosecute or in any way aid in prosecuting any claim, demand, action or suit against the United States Government* for any loss, damage or injury to my person or property that may occur for any case whatsoever as a result of my participation in this event.
3. I also understand and agree that I may be held liable for any damage or loss to the United States Government*caused by my negligence, willful misconduct or fraud.
 
I have read this Release and Hold Harmless Agreement and understand all of its terms.  I execute this Release and Hold Harmless Agreement voluntarily and with full knowledge of its significance.
 
*United States Government as used here, includes the United States Department of Interior, Pea Ridge National Military Park, www.arkansasrunner.com and any agency instrumentally, officer, civilian or employee of the United States, acting officially or otherwise.