Boon Park Playground and Dexter Cross Country 5K/1-Mile Fun Run

SEPTEMBER 26, 2020
INDIVIDUAL REGISTRATION

THIS IS NOT A SANCTIONED RUN AND IS A FUNDRAISER EVENT

CHECK IN STARTS AT 7AM 5K STARTS AT 7:30AM DEXTER HIGH SCHOOL
CHECK IN STARTS AT 7:30AM 1-MILE DONUT FUN RUN STARTS 8:00AM CENTRAL SCHOOL CIRCLE

EARLY BIRD REGISTRATION DEADLIINE IS SEPTEMBER 17, 2020 (EARLY BIRD GUARANTEE SHIRT/GOODIE BAG)
MEDALS GIVEN TO TOP 3 IN EACH GROUP
RUNNERS MAY REGISTER DAY OF THE RACE--NO SHIRT GUARANTEE

RUNNER'S NAME *
BIRTH DATE * / MM / DD YYYY
PHONE * - ### - ### ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email Address *
SHIRT SIZE *

SHIRT SIZE YOUTH SMALL YOUTH MEDIUM YOUTH LARGE ADULT SMALL ADULT MEDIUM ADULT LARGE ADULT XLARGE
RUNNING DIVISION *

RUNNING DIVISION MALE FEMALE
SELECT EVENT *

SELECT EVENT 5K RUN 1 MILE RUN
RUNNING DIVISION *

RUNNING DIVISION 19U 20-29 30-49 50+
CHECK BOX *
I UNDERSTAND THE IS NOT A SANCTIONED RUN AND IS A FUNDRAISER EVENT
CHECK BOX *
I UNDERSTAND THE DANGER OF EXPOSURE TO COVID-19 EXISTS. BY ENTERING THIS COMMUNITY EVENT, I TAKE FULL RESPONSIBILITY FOR MY OWN PROTECTION AS WELL AS MY CHILD'S, FOR THE RISK THAT I MAY CONTRACT COVID-19. I ALSO ASSUME THE SAME RESPONSIBILITY FOR DISINFECTING HAND AND ANYTHIN I TOUCH. I WILL MAINTAIN AT LEAST 6 FEET BETWEEN MYSLEF AND OTHER PEOPLE WHO ARE NOT A PART OF MY HOUSEHOLD. I WILL NOT ATTEND EVENT IF MYSELF OR ANY MEMBER OF MY HOUSEOLD HAVE BEEN SICK OR NOT FELT WELL IN THE PAST TWO WEEKS.
IF RUNNER IS UNDER 18 PARENT SIGNATURE REQUIRED

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Registration Confirmation
You will receive a email confirmation stating DPR received your registration form. If you do not receive confirmation of registration please contact the park office 573-624-8244, it is your responsibility to confirm receipt of registration form. If DPR does not receive your registration and you do not have proof of registration (screen shot or email) your registration will not be accepted.
Payment Option *

Payment Option Pay Online Pay in Park Office Payment left in drop box

NO REFUNDS.

ALL PAYMENTS WILL BE PROCESSED THROUGH PAYPAL AFTER REGISTRATION FORM IS SUBMITTED.
Draw your signature into the box below. *

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Signing below gives Department of Parks and Recreation and its assigns, both during and anytime after, to use their likeness, name, voice, or words in either television, radio, film, newspaper, magazines, social media, and other media, and in any form, for the purpose of advertising or communication the purpose and activities of the Department of Parks and Recreation.