* 1. Name

* 2. Gender

* 3. Address

* 4. Email

* 5. Age

* 6. Do you have a child participating in the Fun Run? (Ages 12 and under)

* 7. How many children ages 12 and under will be participating in the Fun Run?

* 8. Are you a veteran?

* 9. Upon completion of this online registration, I hereby waive and release Southeastern Community College or any individuals or organizations who assist or support the Star-Spangled 5k Walk/Run and Kids Fun Run from any liability from illness or injuries I may suffer as a direct or indirect result of my participation. I further state that I am in proper physical condition to participate in this event and I understand that running a race is a potentially hazardous activity. I consent to be treated by licensed medical personnel if an emergency occurs, although Southeastern Community College will have no liability for payment of any costs of such treatment. I understand and agree that the decision of the officials is final.