Shaver Shuffle 5k Registration
Thank you for your interest in the Shaver Shuffle.
Please complete the form below and hit submit to proceed to the payment page.
Team Name (If participating as part of a group or team)
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Please Select Your Shirt Size
As a participant in The Shaver Shuffle 5K, I, for
myself, personal representative, administrators, heirs, devises and assigns do hereby discharge the Randy Shaver Cancer Research and Community Fund, the event site, their management, their ofﬁcers, board members, employees, members, sponsors, volunteers, organizers or their representatives, or their successors and all cooperating
businesses and organizations from all claims of damages, demands, actions, illnesses, death and causes whatsoever in any matter arising from or related to of my participation or that of my child in the event.
I agree to indemnify the Randy Shaver Cancer Research and Community Fund for all ﬁnes, fees and expenses incurred as a result of the breach of any contractual obligations of the Shaver Shuffle Participant. I attest and verify that I am, or my child (under 18), is medically able to participate and assume all risks of participation in this event.
I understand that I may be photographed, ﬁlmed or videotaped at the event. I hereby irrevocably grant to Randy Shaver Cancer Research and Community Fund, its afﬁliates, licensees and collaborators the absolute right and permission to use my likeness and/or voice for any purpose whatsoever, including commercial advertising.
I state that I am physically ﬁt and able to run in the Shaver Shuffle 5K Race and I have trained sufﬁciently for this event. I also give my full permission for such ﬁrst aid as deemed
necessary to be provided to me or my child on the premises or prior to transport to a hospital for further treatment.
If the participant is under the age of 18, a parent or guardian needs to give consent for them to participate in the Shaver Shuffle 5k and have agreed to all of the Shaver Shuffle Participant Terms and Conditions on their behalf.
I understand that the $30 registration fee is a non-refundable donation to the Randy Shaver Cancer Research and Community Fund in case of withdrawal on my part or cancellation due to inclement weather.
Your electronic signature is the online equivalent of your ink-on-paper signature, and can be provided by typing your name where indicated. The electronic signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements: I have read, have understood, and do accept the agreement above.
I understand that this is a legal document with effects that I approve and authorize. The registrant is the person(s) whose name is submitted as the recipient of the goods and services provided as a result of this transaction.
I am authorized to agree to the terms of this document on behalf of the registrant. If the registrant is under 18 years of age, incapacitated, or mentally challenged, I assert that I am the parent/legal guardian or otherwise authorized to execute a legally binding agreement on behalf of the registrant.
You must be 18 years of age to legally complete this registration. If the registrant is under 18, an authorized adult must complete this form.
If the person you are registering (registrant) is under 18 enter his/her age in the space below. Enter your age after your name in the signature field as the person filling out the form.
I agree to the terms stated above
If registrant is under 18, please enter the age on the day of the race of the registrant below.
Provide your electronic signature by typing your name:
Multiple signers should separate their signatures with commas.
Type the characters from the image below.
Do Not Fill This Out