Tater Trot 5K Registration

Runner Information *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Age *

Gender Identification (Optional) *

Female
Male
Other

Other

I would like a shirt ($15) *

Yes
No

T-Shirt Size *

Other

Specify shirt size

Emergency Contact *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Payment *

Optional Donation

All proceeds and donations go towards funding Tater Tots' clinical services and community programs for youth and families in the Klamath Basin

Other

Total Due Today

$ 0.00

Participation Waiver *

I acknowledge that running a road race is a potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event, including but no limited to: falls, physical contact with other participants, volunteers, race personnel, contract service providers, employees, and spectators including the potential the contraction of a communicable disease resulting from contact with other participants, volunteers, race personnel, contract service providers, employees, and spectators. I assume all risks including: the effects of the weather; high heat and/or humidity; freezing cold temperatures; traffic and the conditions of the road including surrounding terrain. I understand that bicycles, skateboards, roller skates or inline skates, animals, and personal music players are not allowed in the race, and I will abide by all race rules. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Tater Trot hosted by Tater Tots Pediatric Therapy, the city of Merrill, OR, and The Merrill Lions Club, all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purposes. I understand that this event does not provide for refunds in the event of a cancellation, and by signing this waiver, I consent that I am not entitled to a refund if the event is cancelled before or during the event.

Signature (Parent Signature if Runner is Under 18) *

You agree your E-Signature is the legal equivalent of your manual signature on this registration form, as if actually signed by you in writing.

Tater Trot 5k Registration