Independence 4K Registration Form

Page 1

Thursday, July 4th Municipal Park - 1921 N. Bicentennial Blvd. - McAllen 6:00 p.m. Check-in 7:00 p.m. Race Start Fireworks Extravaganza 9:00 p.m.

The City of McAllen Parks and Recreation department has partnered with Team RWB McAllen-Edinburg, a national veterans organization, to bring the Independence 4K as one of the elements in our McAllen Independence Day Celebration Presented By H-E-B. Enjoy food trucks, moon jumps, live entertainment and family fun at the Concert in the Sky event after the race! First 300 to register will receive a t-shirt and medal.

REGISTRATION FORM PARTICIPANT NAME:

MALE

FEMALE

PARENT/GUARDIAN NAME (IF UNDER 18) ADDRESS: CITY:

DATE OF BIRTH: STATE:

ZIP:

AGE:

EMAIL:

EVENT (SELECT ONE)

PHONE:

5K RUN/WALK

7 & Over

$20.00

#231000.01

All participants must read and sign the following waiver of legal liability: I, the undersigned, do hereby agree to release and hold harmless the City of McAllen, and its agents, employees and all volunteers from any and all liability resulting from my participation in the Independence 4K. Photos are taken during the special event. I understand that these photos are for the Parks & Recreation Department's use only, and may be used in future guides or publications. I do hereby grant permission for photos to be taken of myself and my child for purposes of publicity.

Signature (Parent/legal guardian if under 18)

PRINT NAME Parent/Legal Guardian

PLEASE MAKE ALL CHECKS PAYABLE TO: CITY OF McALLEN FOR OFFICE USE ONLY: DATE:

RECEIPT#:

CASH/CHECK #


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