Fit 4 Change 5K
This is a FREE 5K event. Victory Sports Foundation will be accepting donations to fight obesity!
Run/ Walk Start: 6:00 p.m.

We want to make this the LARGEST 5K yet.

Welcome to all Mississippi residents!
Come watch, walk or run!

 

 

Online Sign-up Form

Participant Information

First Name

Last Name

Street Address

City

State

Zip Code

E-mail

Date of Birth

/ /

Gender

Home Phone

format: xxx-xxx-xxxx (include area code)

Cell Phone

format: xxx-xxx-xxxx (include area code)

Work Phone

format: xxx-xxx-xxxx (include area code)

 

If Applicable:
Name of Paul Lacoste Sports Fit 4 Change presented by St. Dominic’s Health Services participant that invited you to the 5K?

 

Release and Waiver

I, the undersigned, in consideration of acceptance of the entry and registration as participant in the Paul Lacoste Sports Fit 4 Change 5K, waive any and all claims which I and my heirs or assigns may now or hereafter have against Paul Lacoste Sports/Next Level Sport LLC, Victory Sports Foundation, it’s members, Mississippi Race Timing and all Partners/Sponsors of this event which may indirectly or directly result from my participation in the Paul Lacoste Sports Fit 4 Change 5K. I further warrant and represent that I am in proper physical condition to participate in the Paul Lacoste Sports Fit 4 Change 5K and am not participating in this event against physician’s advice nor am I taking medications which would impair my health or ability to participate in the Paul Lacoste Fit 4 Change 5K.

Parent or Guardian Information

Parent/Guardian Full Name

I permit my child to participate the Paul Lacoste Sports Fit 4 Change 5K and waive any and all claims which I and my heirs or assigns may now or hereafter have on their behalf.

 

To verify your registration, please type the word that appears below.