03/16/2019 @ 8:00am
Food Shuttle Garden Gallop 5K Run/Walk
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Food Shuttle Garden Gallop 5K Run/Walk Registration Form
Register for the Food Shuttle Garden Gallop 5K Run/Walk on March 16th, 2019 at 8:00AM!
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Virtual Runner - support the race but do not want to run!
Virtual Runner - support the race but do not want to run! -
Kids 12 and under
Participant First Name
Participant Last Name
- month -
- day -
- year -
Antigua and Barbuda
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Cocos (Keeling) Islands
Congo, the Democratic Republic of the
Falkland Islands (Malvinas)
French Southern Territories
Heard Island and McDonald Islands
Holy See (Vatican City State)
Iran, Islamic Republic of
Isle of Man
Korea, Democratic People's Republic of
Korea, Republic of
Lao People's Democratic Republic
Macedonia, the former Yugoslav Republic of
Micronesia, Federated States of
Moldova, Republic of
Northern Mariana Islands
Palestinian Territory, Occupied
Papua New Guinea
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Sint Maarten (Dutch part)
South Georgia and the South Sandwich Islands
Svalbard and Jan Mayen
Syrian Arab Republic
Taiwan, Province of China
Tanzania, United Republic of
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
United States Minor Outlying Islands
Venezuela, Bolivarian Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
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District of Col.
Emergency Contact Name
create a new fundraising team
- not on a fundraising team -
#2007 - Monsant-NO (captain Jacob Rutz)
Select your t-shirt size
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Affiliated Club, Team, or Organization
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new team name
select or enter a team name
We'll be raffling off products from local businesses around Raleigh! Add a ticket to your purchase to support IFFS further and have a chance to win prizes!
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InterFaith Food Shuttle's Urban Agriculture Education Initiative
(learn more about this cause)
According to Feeding America, 1 in 4 children are at risk of hunger in North Carolina. In the Food Shuttle's seven county service area alone, over 118,000 children applied for free and reduced price meals last year. There is a huge demand for support as schools attempt to integrate garden based nutrition education into their curriculum.
READ THIS DOCUMENT (THE "WAIVER AGREEMENT") CAREFULLY BEFORE SIGNING. THIS WAIVER AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS AND WILL LIMIT OR ELIMINATE YOUR ABILITY TO BRING A FUTURE LAWSUIT. RELEASE AND WAIVER OF LIABILITY AGREEMENT Undersigned athlete (“Athlete”) on behalf of himself/herself and on behalf of Athlete’s personal representatives, assigns, heirs, executors, and successors hereby fully and forever releases, waives, discharges and covenants not to sue FS Series, its affiliated corporations and charities, the host city(ies), county and state, USATF, any and all municipal agencies whose property and/or personnel are used or in any way assist, all sponsoring or co-sponsoring companies or individuals related to the Event, together with their officers, directors, shareholders, successors and assigns, (collectively “Releases”) from all liability to the Athlete, his/her personal representatives, assigns, heirs, executors, and successors for any and all loss(es), damage(s), and any and all claims or demands therefore, account of injury to Athlete, his/her property or resultant death, whether caused by the active or passive negligence of all or any of the Releases or otherwise, in connection with Athlete’s participation in the Event. Athlete represents and warrants that he/she is in good physical condition and is able to safely participate in the Event. Athlete is fully aware of the risks and hazards inherent in participating in the Event and hereby elects to voluntarily participate, knowing the risks associated with the Event. Athlete hereby assumes all risks of loss(es), damage(s), or injury(ies) that may be sustained by him/her while participating in the Event. Athlete agrees to the use of his/her name and photograph in broadcasts, newspapers, brochures and other media without compensation. Athlete acknowledges that the entry fee paid is non-refundable and non-transferable. Athlete acknowledges and agrees that the "Event" and FS Series in its sole discretion, may delay or cancel the Event if it believes the conditions on race day are unsafe. In the event the Event is delayed or cancelled for any reason, including but not limited to: fire, threatened or actual strike, labor difficulty, work stoppage, insurrection, war, public disaster, flood, unavoidable casualty, acts of God or the elements (including without limitation, rain, hail, hurricane, tornado, earthquake), or any other cause beyond the control of the "Event" and FS Series. There shall be no refund of the entry fee or any other costs of Athlete in connection with the Event. The Athlete hereby grants to The Medical Staff of the Event, and his/her agents, affiliates and designees, access to all medical records (and physicians) as needed and authorizes medical treatment as needed. Athlete understands that they have the rights to refuse medical care and advice of Event medical directors and representatives; if Athlete’s medical condition becomes such that the Athlete’s mental capacity is questioned, the physician has the right to recommend and initiate treatment of Athlete. It is understood and agreed that Athlete hereby assumes liability for any and all medical expenses incurred as a result of training for and/or participation in the Event, including but not limited to ambulance transport, hospital stays, physician and pharmaceutical goods and services. Athlete warrants that all statements made herein are true and correct and understands that Releasees have relied on them in allowing Athlete to participate in the Event. I understand that bicycles, skate boards, roller skates or inline skates, animals and musical devices of any type are not allowed in this event and I will abide by this rule. The parent or legal guardian who signs the Waiver Agreement on behalf of a minor, incapacitated and/or mentally challenged person (hereinafter "Said Person"), hereby acknowledges that he or she has the legal capacity and authority to act on behalf of Said Person to legally bind Said Person to the Waiver Agreement. The parent or legal guardian who signs the Waiver Agreement agrees to indemnify and hold harmless the Released Parties for any expenses incurred, Claims made, or liabilities assessed against them, as a result of any insufficiency of legal capacity or authority to act on behalf of Said Person in the execution of the Waiver Agreement. FS Series reserves the rights to use your email address for FS marketing only and releases your information to event photographer for photos. If any provision of this Waiver Agreement shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Waiver Agreement and shall not affect the validity and enforce-ability of any remaining provisions. THE PARTICIPANT FULLY UNDERSTANDS THE FOREGOING CONDITIONS OF THE EVENT. BY CHECKING YES, THE PARTICIPANT HAS READ AND FULLY UNDERSTANDS THE WAIVER AGREEMENT.
Read through the agreement
I have read and agreed to the waiver above
Are you 18 or older?
18 or older
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian. If registering a child under 13, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Discount, Tracking, or Charity Code
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Visa or Master Card
Credit Card #
click the "pay now" button to submit your order then send a check (or pay in person) at the address above.
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