Participant Registration Name* First Last CompanyEmail* Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Birth Date* Date Format: MM slash DD slash YYYY Gender*MaleFemaleFees*$25 | Adult Registration$10 | Youth - 17 and UnderT-Shirt Size*YSYMYLSmallMediumLargeX-LargeXX-LargeXXX-LargeMake a Donation You can take your first step in supporting The Dawn Brancheau Foundation. Start your fundraising by making a personal donation. Enter the amount below:Participant Waiver* I agree to the participant waiverI wish to participate in the The Dawn Brancheau Foundation Dream Big 5K. I understand the acceptance of the waiver is required to participate in the Event. I further understand I am solely responsible for my health and safety, and I acknowledge that I am physically capable of participating in and completing this Event. I agree to abide by any decision of an event official relative to my ability to complete this event safely and I further agree that event officials or volunteers may authorize necessary emergency treatment for me. If I am injured as a participant in the Event, I agree to assume all risks and to release and hold harmless, The Dawn Brancheau Foundation and its officers and representatives. I agree to allow The Dawn Brancheau Foundation, and their contractors, agencies and sponsors, the use of my name and likeness in connection with this event, for any purpose related to advertising or promotion of the event worldwide in perpetuity in all forms of media. I have carefully read this Waiver and Release and fully understand its contents. I am aware that this is a RELEASE OF LIABILITY and a contract between me and the persons and entities mentioned above and that I accept of my own free will. If the participant is under 18 years of age at the time of registration, the participant’s parent or legal guardian must completely review this Waiver and Release. The parent or legal guardian understands and consents to its terms, and authorizes the participation of the registrant by his/her acceptance below. Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.