Please fill out the form below to join the Kids 4 Kids program with Team Believe. A $30 donation is payable through PayPal after completing the form. Thanks for joining!

First Name: MI: Last Name:

Gender: |   Email: Phone number:

Address: City:
State: ZIP:

Guardian/emergency contact: Phone number:

Date of birth:

Goal race: |

Shirt size: | | | |

I understand and accept that running and/or walking is a potentially hazardous activity.  By my acceptance below I attest and verify that the registered child is medically able and physically fit to participate in this program.  In consideration of your accepting this entry form I, the undersigned, having appropriate legal authority and intending to be legally bound hereby, for myself and as parent/guardian of the registered child, our respective heirs, assigns, executors and administrators, waive and release any and all claims I, or the registered child now have, or in the future may acquire, against Team Believe Inc., its  officers, directors, employees, volunteers or sponsors, and their respective representatives, successors, heirs and assigns, for any and all injuries suffered and/or damages incurred, as a consequence, whether in whole or in part, of participation in said Team Believe, Inc. program by the registered child including, but not limited to, any training schedule, activity or event sponsored or conducted by Team Believe, Inc. individually or in conjunction with others, and including  participation by the registered child in the 2015 Mountain Goat 3K Run or Kid's Run on May 3, 2015.  I hereby grant permission to Team Believe Inc., and any other sponsors of Team Believe, Inc., to use all information submitted in this entry, and any record containing the registered child’s likeness, as well as race results, including name and competition time, for any purpose whatsoever.

I accept: