Let Your Light Shine Family 1 Mile Walk & 5k

Online Registration Form

Let Your Light Shine Family 1 Mile Walk & 5k
9th Annual Let Your Light Shine Family 1 Mile Walk & 5k

Saturday, May 20, 2023

7:30am: Check-in & Silent Auction Begin

8:30am: Group Photo followed by Family 1 Mile Walk & 5k

First Baptist Church, 1121 Main St, Goodland, KS

...OR Virtual Event in Spring Hill, KS
PARTICIPANTS & QUANTITY: Check, then Select Quantity*
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ADULT (one form per adult)$20.00

Please Select QUANTITY
Item subtotal:$0.00

STUDENT(S) (Ages 5-18) $15.00

Please Select QUANTITY
Item subtotal:$0.00

CHILD(REN) (Ages 0-4 with T-shirt)$15.00

Please Select QUANTITY

CHILD(REN) (Ages 0-4 without T-shirt) $ Free

Please Select QUANTITY

Online Convenience Fee - per # of participants (maximum $3 fee)$1.00

Total # of Participants
Item subtotal:$0.00

Total $0.00
This Total is Correct Based on the (Amount for Each) x (My Total # of Participants). (If not, please make sure the correct "Quantity" is selected under each check box.)*

Yes
ADULT / GUARDIAN Full Name (Please fill out parent/guardian name - even if adult is not participating)*

First NameLast Name
T-Shirt Size
If no adult participating, please select t-shirt size(s) under each child's name below (and leave this field blank)
E-mail*
example@example.com
Contact Number*

Area CodePhone Number
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Additional Entries Info

STUDENTS & CHILDREN - Please list each Student/Child - to match the Total # of Student(s) and/or Child(ren) Participants listed above
1. Student/Child Full Name

First NameLast Name
T-Shirt Size
2. Student/Child Full Name

First NameLast Name
T-Shirt Size
3. Student/Child Full Name

First NameLast Name
T-Shirt Size
4. Student/Child Full Name

First NameLast Name
T-Shirt Size
Any Additional Students/Children in your family participating (Please include T-Shirt sizes) and/or Any Additional Info we need to know:
We Will be Participating in:

Goodland (in person event)Spring Hill (virtual event)
I/We would like to participate in the (if you're not sure, no worries, you can change this on the day of the event!). :)

1 Mile Family Walk OR5k
How did you hear about the Let Your Light Shine Family 1 Mile Walk & 5k?*
I understand the t-shirt deadline is May 4th; if registration is submitted after this date, I understand I/we will not get a t-shirt(s).*

Yes
Waiver of Liability: In consideration of my participation in this event, I the undersigned release any and all claims for damages during the event. I hereby release The City of Goodland, KS and The City of Spring Hill, KS, First Baptist Church, Life Spring Church, organizers, volunteers, sponsors, and all associated with the Let Your Light Shine cause from any and all liability associated with this event or otherwise. I understand there are no refunds if the event needs to be cancelled due to weather, coronavirus, or any other unforeseen circumstances. I grant permission for taking photographs or videos to be used to promote www.letyourlight-shine.com events. I attest and verify that I am physically fit and sufficiently trained for the walk/run event.
I have read, understand, and agree to the waiver of liability*

Yes
SIGNATURE by Parent/Guardian (for adult and for any minors ages 0-18 listed on form)*

Clear
Should be Empty:

Online Registration Form

Additional Entries Info