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New Year, New You!
New Year, New You
Fun Run and Kick-off Event
2nd Annual Healthy Eating Active Living “New Year, New You” Kick-Off Event
*
1.
First Name
(Required.)
*
2.
Last Name
(Required.)
3.
Gender
Female
Male
Gender Diverse
Prefer not to say
4.
Email Address
(
Optional but strongly encouraged to receive information on future HEAL events.)
*
5.
Address
(Required.)
City
Zipcode
6.
Phone
*
7.
I will participate in
(select all that apply)
(Required.)
1 Mile Fun Run/Walk
5K Fun Run
Vendor Fair
8.
Will you be participating with a wheelchair, stroller, or bicycle?
**Please note, that for optimal safety and experience, those with wheelchairs, strollers, and bicycles will begin from the back of the start line.
Not applicable to me
Wheelchair
Stroller
Bicycle
Other (please specify)
9.
Are you interested in purchasing a 2020 HEAL Fun Run T-shirt for $10?
Cash Only
Yes
No
10.
Please indicate your t-shirt size
Adult Small
Adult Medium
Adult Large
Adult XLarge
Adult XXLarge
11.
Would you be interested in providing feedback via an email survey following the event?
Yes
No
*
12.
I have received, viewed, and agree to the following attachments.
Documents can be found at www.gchd.org/HEAL
(Required.)
HEAL Fun Run Liability Waiver
ITT Community Challenge Registration
