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The Dylan Earven Foundation  © 2014 - 2019  • All Rights Reserved
Pre-Registration Form
Team or Individual Name
Team Captain Name
Parent's Name for Minor Participant(s)
Email Address
Phone
Mailing Address
City, State, Zip
Emergency Contact Name:
Emergency Contact Phone:
   
   
Names of all Participants
and Event Type(s)
 Participant #1
Name:

Select Event (select as many as applicable)

5K Walk/Run     [Yes    I am requesting to be timed for the run]

1K Walk/Run      [Yes    I am requesting to be timed for the run]

Trike Race (3 to 5 years old)

Bike Race (6 to 8 years old)

Bike Race (9 to 11 years old)



Participant #2

Name:   

Select Event (select as many as applicable)

5K Walk/Run   [Yes    I am requesting to be timed for the run]

1K Walk/Run   [Yes    I am requesting to be timed for the run]

Trike Race (3 to 5 years old)

Bike Race (6 to 8 years old)

Bike Race (9 to 11 years old)


Participant #3

Name:   

Select Event (select as many as applicable)

5K Walk/Run   [Yes    I am requesting to be timed for the run]

1K Walk/Run    [Yes    I am requesting to be timed for the run]

Trike Race (3 to 5 years old)

Bike Race (6 to 8 years old)

Bike Race (9 to 11 years old)


Participant #4
Name:   

Select Event (select as many as applicable)

5K Walk/Run   [Yes    I am requesting to be timed for the run]

1K Walk/Run    [Yes    I am requesting to be timed for the run]

Trike Race (3 to 5 years old)

Bike Race (6 to 8 years old)

Bike Race (9 to 11 years old)


Participant #5 
Name:  

Select Event (select as many as applicable)

5K Walk/Run   [Yes    I am requesting to be timed for the run]

1K Walk/Run    [Yes    I am requesting to be timed for the run]

Trike Race (3 to 5 years old)

Bike Race (6 to 8 years old)

Bike Race (9 to 11 years old)



Participant #6
Name:   

Select Event (select as many as applicable)

5K Walk/Run    [Yes    I am requesting to be timed for the run]

1K Walk/Run     [Yes    I am requesting to be timed for the run]

Trike Race (3 to 5 years old)

Bike Race (6 to 8 years old)

Bike Race (9 to 11 years old)

   
Additional Participants:

(Complete name and event for each additional participant if you have more than 6 in your group)

Upon submission of this registration form, you will be directed to the payment page to pay for your events.

Payments are powered by PayPal, but you do not need to have a PayPal account to pay.  You can check out using your credit card.

Please Note:  Registration is not complete until payment is made.

   Waiver Form Completed

Additional Donation?     (An additional donation can be made on the event payment page.)

 

Waiver Form
This waiver is required for each member of your family. 
Please download, print and bring with you when you check in at the event.
Thank You