5K Run/Walk: 6 & Under WALK/RUN - Registration Event Date* - Select Event Date - First Name* Last Name* * Required Address* * Required Address 2 City* * Required State* Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana International Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming * Required Zip Code* * Required Email Address* * Required Phone* * Required Invalid Phone Number Alt Phone Invalid Phone Number Gender MaleFemale Cancer Survivor YesNo T-Shirt Size* Select Small Medium Large XL 2XL 3XL Age * Required HOLD HARMLESS AND WAIVER OF LIABILITY The person registered agrees to assume responsibility for and further agree to indemnify, defend and to hold Thibodaux Regional Health System, its agents, officers and employees harmless from any loss or liability for or an account of injury to (including death of) persons or damage to property, including costs, attorney fees and expenses incidental, thereto, arising from participation in the “5K Run/Walk: 6 & Under WALK/RUN, ” whether or not said losses, injuries, deaths or property damages arise partially or wholly from the fault of Thibodaux Regional Medical Center, its agents, officers and employees. I understand that in the event I or my child is injured while participating in the aforementioned activity, I am responsible for any and all medical bills and expenses that may arise from said injury. If my child is participating and I am not present at the event, I give my permission to send my child to the nearest emergency department for treatment. This may include ambulance transportation if necessary. Event may include photo and/or video recording with or without audio. I hereby grant permission to the rights of my image, likeness, and sound of my voice as recorded on audio or video tape without payment or any other consideration. I agree * Required How Did You Hear About Us? Select Internet Search From a Friend Healthcare provider From a Caregiver From Newspaper Social Media Other Register