Cuke Patch 5K Glow Run Form Left ornament Right ornament

Cuke Patch 5K Glow Run

    2019 Entry Form

  • ***Pre-registration must be received by March 15, 2019 to guarantee Official Cuke Patch 5K Shirt on Run Night.

  • Pre-registered Runner: $20/person
    Runner registration after April 1: $25/person
    Pre-registered Team Rate (4 or more): $15/person
    Team registration after April 1 (4 or more): $20/person

  • All participants must sign form. If under 18 years of age, a parent or guardian must complete and sign below. Runners under the age of 12 must be accompanied at all times by a parent or guardian.

    RELEASE OF ORGANIZERS AND SPONSORS of the Cuke Patch 5K Glow Run (the Event.) In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators, assigns and/or legal representatives, do hereby waive, release and discharge the Mount Olive Area Chamber of Commerce, the Town of Mount Olive, NC, the sponsors and all Event personnel from any and all claims for damage suffered by me as a result of my participation in or travel to or return from the Event. In addition I certify that I am in proper physical condition to participate in the Event and accept full responsibility for my own safety during the Event.

  • PARENT or GUARDIAN of Minor Child (Under 18 Years of Age): I, as a parent or guardian of the below named minor(s), hereby give permission for my child(ren) or ward(s) to participate in the Event and further agree individually or on behalf of my child(ren) or ward(s) to the terms of the above Release of Organizers and Sponsors.





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