Hospice Hustle5K Run/Walk & 1 MileOctober 5th, 2024 9:00 AM 7th Street Complex Disco Attire Optional Flyer | Download Form Full Name(Required) First Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Male Female I'm racing in:(Required) 5k 1 Mile Email(Required) Phone(Required)Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Register by August 28to get a race shirt!Unisex Shirt Size:(Required) X-Small Small Medium Large X-Large 2XL 3XL In Memory Mile Markers Race in memory of a loved one. Send us a photo to be displayed on one of our mile marker signs. Upload photos here or send photos to: egosnell@bluemoutainhospital.orgAccepted file types: jpeg, jpg, png, pdf, Max. file size: 20 MB.I'm racing in memory of: Acknowledgement of Risk and Waiver of Liability.(Required) I agree and accept all terms and conditions set forth herein.Read this Acknowledgement of Risk and Waiver of Liability carefully and in its entirety. It is a binding legal document. If you are under the age of 18, this form must be signed by your parent or legal guardian. I know that participating in the BMHD Hospice Hustle Race is a potentially hazardous activity and I should not enter and participate unless I am medically able and properly trained. I acknowledge and assume any and all risks associated with this event including, but not limited to, traffic on the course route, falls, contact with other participants, and the condition of the course, including, but not limited to, curbs, cars, uneven pavement, potholes, rocks, and objects on the course surface. Knowing and appreciating these risks and in consideration of your acceptance of my entry, I hereby for myself, my heirs, representatives or anyone else claiming on my behalf, covenant not to sue, and waive, release, and discharge Blue Mountain Hospital District, its volunteers, and sponsors, and anyone else acting for or on behalf the Hospice Hustle from any and all claims of liability for death, personal injury, or damage of any kind arising out of my participation in this run. This Acknowledgement of Risk and Waiver of Liability extends to all claims of every kind whatsoever. I also consent to emergency treatment in the event of injury or illness. I grant full permission to BMHD and/or any person or entity authorized by it to use my name, age, date of birth, finish place and finish time in the public domain. I further grant full permission for BMHD to use any photographs, recordings, or any other record of this event for any purpose. By checking the consent box, I acknowledge that I have read the above waiver and I agree and accept all terms and conditions set forth herein.Registration Fee:(Required) Price: Credit Card(Required)