Family Fun Obstacle Challenge & 5k Run

Name

Address

Phone

Gender

Male Female

Age Range

2-13 years 14-18 19-29 30-49 50-65 65 or above

This address will receive a confirmation email

Team Information

A Team consist of 2 or more people, this can be adult with adult, adult and child or child with child and long as one child is 13 or older. You will be given options to join a team or we can place you on a team if you prefer the choice is yours. Please list Team Captains Names if you already have a team.

select which event(s) you will be particapating in.

Would you like for us to place you on a team

Are you the team captain? Yes No

Name of Captain for your team

Please list name of team you would like to be placed on. Remember to keep team names fun and appropriate. If this team name has already been taken someone will contact you for a different name.

Please select T-Shirt Size (additional cost for each size over XL will be $1.50)

youth small youth med youth large youth XL Adult small Adult Med Adult Large Adult XL Larger than an XL list size below and please include the upsize fee in the donation box provided.

If ordering any extra t-shirt or have an size larger than adult XL please list the following here. The box below is where you will select for tshirt payment. This is for extra or upsizes only. Otherwise your shirt fee is included with registration cost.

You will need to include extra t shirt fees here or you are welcome to make extra donations to Mt Zion ministries. Thank you

Emergency Contact Name

Emergency Contact phone number

Are you 18 years of age or older

Yes No

You understand that If you are under the age of 18 a legal gaurdian or parent must be available to sign consent form the day of the event

Yes No

You agree and abide by all rules and guidelines of Mt Zion Church such the following. No use of tabcoo or alcohol allowed on property. No profanity or rude aggresive behavior. You understand this event is a challenge intended for fun & for all to enjoy. We are not responsible for any lost or stolen items. We are not responisbel for any accedients or injuries and you are aware it is to be challenging. However you will be mindful and cautions of all bodies in which you are surrounded including your own. You also acknowledge that your children are your responsibility. Please select yes or no if you agree or disagree.

Yes NO

Payment make sure if you are particapating in both event or just one that you select appropriate age group. (after August 2nd registration price will increase)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Family Fun Obstacle Challenge & 5k Run

Description

Please Fix the Following