Step 1 of 4 (Registration Agreement)

Galloping Gobbler 2022

Thursday, November 24, 2022 in Fort Wayne, IN at University of Saint Francis - Hutzell Athletic Center - 1400 Leesburg Road

  • 4 Mile - Individual Registration

  • 4 Mile - Family Registration
    Family discount of $2 per entry when registering 4 or more participants in one transaction.

* Click here for fee information

WAIVER: (Must be signed by entrant, parent or legal guardian)

I know that running a race is a potentially hazardous activity and I should not enter this event unless I am medically able and properly trained. I realize the course presents a number of potential dangers to me and I assume all risks associated with this event. I realize I will be running on a number of different surfaces, such as, but not limited to, asphalt, concrete, grass, gravel, and hills and conditions may include rain, snow and ice. In consideration of my participation in this event, I, for myself, my heirs, executors, personal representatives, administrators, assigns or anyone entitled to act on my behalf, waive and release the organizers, volunteers, sponsors, Veep Races LLC, eRunner Timing & Results,
Running Around Screen Printing, City of Fort Wayne, University of Saint Francis, Lindenwood Cemetery, Service Corp Intnl. and the Road Runners Club of America from all claims and liabilities, actions, demands or damages of any kind arising out of my training or participation in this event. In the event of my injury or illness during the race, I waive confidentiality under(HIPPA) Health Insurance Portability and Accountability Act and direct that emergency medical personnel, physicians, clinics, hospitals or other medical personnel release my name, nature of injury and illness and extent of treatment to the Race Director. I understand that strollers, dogs, and audio headsets are prohibited. I authorize my likeness to be used for any lawful purpose. My application for entry may be refused in the sole discretion of the race organizers and I understand that there are no refunds in the event of cancellation due to severe weather or as a result of a natural or manmade emergency

Please Sign Below

Your electronic signature is the online equivalent of your ink-on-paper signature, and can be provided by typing your name where indicated. The electronic signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements:

  • I have read, have understood, and do accept the agreement above.
  • I understand that this is a legal document with effects that I approve and authorize.
  • The registrant is the person(s) whose name is submitted as the recipient of the goods and services provided as a result of this transaction.
  • I am authorized to agree to the terms of this document on behalf of the registrant.
  • If the registrant is under 18 years of age, incapacitated, or mentally challenged, I assert that I am the parent/legal guardian or otherwise authorized to execute a legally binding agreement on behalf of the registrant.

Electronic Signature

You must be 18 years of age to legally complete this registration. If the registrant is under 18, an authorized adult must complete this form.
If the person you are registering (registrant) is under 18, do not enter his/her age. You will do that on the next step. Enter your age here as the person completing the form.

Multiple signers should separate their signatures with commas.

This agreement was generated at 6:53:43 AM EDT on 07/06/2022.

Click here to print the agreement.

You are encouraged to keep a copy of this agreement for your records. This agreement was generated at 6:53:43 AM EDT on 07/06/2022

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