8^th year of Sap

Run/Walk/Roll 5k  

REGISTRATION FORM

SATURDAY MAY 17, 2025

Name: ____________________________________

Address: ___________________________________

City: ___________________ State: ___   Zip: _______

Age as of May 17, 2025: _______________________

Circle Shirt Size: Youth: S M L   ADULT: S M L XL XXL   No shirt: ___

Please Make Checks Payable: Healing H’Arts

Mail to: MaryEllen Perry 3 Elm Street, Auburn NY 13021

Or Return To: Kirsta Malone

Release of Liability

I realize that running/walking can be a hazardous activity.  I and my heirs, executors, administrators and assigns do hereby release the organizers, sponsors, race personnel and all members of the Healing H’Arts Equestrian Center, Inc. from responsibility from any damages suffered by me as a result of my participation in this run/walk.  I give my permission for any photos to be taken to be used for promotional purposes.  I attest that I am healthy and fit enough to safely participate on the day of the run/walk. I will take full responsibility for my own safety before, during and after the event.

Signature: _______________________________________ Date: _______________________

Guardian Signature (if under 18): _________________________________________________

Emergency Contact Person: ______________________

Relationship to you: ____________

Emergency Contact Phone Number: _______________________________________________