Firecracker 5K Registration Form
WHEN: July 4th, 2022 @ 9am
PRICE: Adults $25 & Kids $15 (under 12)
STARTING LINE: Florida St. - South of Centers Bank
SHIRT PICKUP/REGISTRATION: The Class Room - 114 S. Main, Greensburg, KS

*Pay in person @ The Class Room or now via PayPal - theclassroomgburg@gmail.com*
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I am registering for: *
Name (First, MI, Last) *
Gender *
Date of Birth *
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Age *
Shirt Size *
Shirt Type *
Address (Street, City, State, ZIP) *
Daytime Phone # *
Email Address *
Payment (Adults - $25 & Kids Under 12 - $15) *
WAIVER - READ BEFORE SIGNING - I know that participation in this event is a potentially hazardous activity. I will not enter or participate unless I am medically able and properly trained. I agree to abide by  all decisions made by any race official as to my ability to safely complete the event. I assume all risks associated with this event, including but not limited to falls, contact with other participants, effects of weather including high heat and humidity, traffic and the condition of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting of my entry, I, for myself and anyone entitled to act on my behalf, waive and release THE CLASS ROOM, THE WILSON FAMILY, WHITNEY KREGAR, RACE OFFICIALS, VOLUNTEERS, and ALL SPONSORS from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purposes. *
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Today's Date *
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