Please fill out the following form to pre-register for
The Women's Care Center's Muddy Pumpkin 5K Run
October 28, 2017 - Dayton
 
Sex *

College Students: Receive $10 Discount with Student ID!
 
Early Bird Registration (through September 30): $40
($35 each for Group Haul - team of 4)
 
Registration (starting October 1): $45
 
Youth Registration: $20
 
Ages 5 and Under: free (will not receive t-shirt or pumpkin) 
 
**Please note: team members not eligible for youth pricing**
 

Your packet will include: Event T-shirt, pumpkin and various goods TBD.
 
Registration * 
Payment Options *
Current Total:
$0.00
Registration is NOT complete until payment is received.

I recognize and acknowledge that there are certain risks of physical injury to participants in the Muddy Pumpkin, and I voluntarily and know-ingly agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I may sustain as a result of said participa-tion, including but not limited to color or mud stains and eye irritation. I further agree to waive and relinquish all claims I may have (or which may accrue to me) as a result of participating in these activities against Women’s Care Center, including its Board of Directors, Executive Di-rector, employees and volunteers, the City of Dayton, race officials, agents, volunteers, sponsors, and the owners and operators of the venue (hereinafter collectively referred to as "Administrators"). Participants registering for the race, programs/activities must recognize that there is an inherent risk of injury when choosing to participate in recreational activities/programs. I agree that I am solely responsible for determining if I am physically fit and/or skilled for the race or activities contemplated by this Assumption and Release. It is always advisable, especially if the participant is pregnant or disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity. I, for myself and my heirs, do hereby fully release and forever discharge the Administrators from any and all claims for injuries, including death or incapacity, illnesses, damages, expenses or loss that I may suffer arising out of, connected with, or in any way asso-ciated with the race, program or activities including injuries caused or associated with transportation to and from the event. I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. When registering online, my online signature shall substitute for and have the same legal effect as an original form signature. PARTICIPATION WILL BE DENIED if I have not signed this waiver before the start of the event. The Administrators reserve the right to remove me from the event due to noncompli-ance without reimbursement. I also give this organization permission to use photographs of me taken at the Muddy Pumpkin and associated events in future event promotion.

Registration is NOT complete until payment is received.