Registration Form

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Registration Form

Diabetic Dash, August 19th at the Jackson Heights High school cross country course.

Brats and hamburgers will be provided by the Jackson heights band and shaved ice will be provided by none other than Vern Andrews.

Registering will be accepted until August 1st. However, if you would like a t-shirt you must register by July 17th. If you have any questions please text (785)364-6155

Please fill out this registration form for each participant individually.

Please have cash or check made out to Jackson Heights Color run the day of the event August 19th

Ages 10-Below are free of charge however you will have to pay for the T-shirt

Top three to cross finish line will receive a medal

First and last name of participant *

Shirt sizes (XS and 2XL will have an additional $2 fee

XXL (extra 2 dollars)

I do not want a shirt

Youth S

Youth M

Youth L

Contact information (Phone Number) *

Please choose between the options *

I would like to pay for registration for $20

I would like to pay for registration and for a T-Shirt for $30

My child is 10 or younger and would like to purchase a shirt for $12

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