Online Registration

Once you have submitted this registration form, a confirmation page will appear.  At that time, you will have the opportunity to pay your registration fee online if you so choose.

Advantages to online payment:

  • Convenient and secure

  • Eliminates the need for a trip to our office

  • Saves you from having to write a check

  • Your registration is complete

  • The additional fee charged for the online payment service ($1.00 for the Dean Kelley, Jr. Memorial Run) is usually cheaper and more convenient than driving across town with the current gas prices

It is not mandatory that you pay at this time.

VERY IMPORTANT:  Please use the TAB key to advance to the next field.  Using the ENTER key to advance to the next field will send the form immediately and cause you to send an incomplete form.

Waiver of Claim Agreement of Terms & Conditions

You must agree to the terms and conditions of the Kids, Incorporated Waiver of Claim in order to complete this online registration form.  Before proceeding, please review this document by clicking here.

 

I acknowledge that I have read, understand, and agree to the terms and conditions of the Kids, Incorporated Waiver of Claim.  The original copy of this online registration form will become part of the official record at Kids, Incorporated.  A copy may be requested at our office located at 27th & Osage in the Kids, Incorporated WareHouse.

Please enter the full name of the individual accepting responsibility for the terms and conditions of the Kids, Incorporated Waiver of Claim.

Name of Individual Accepting Responsibility:        

Participant Information

Event:  
Gender:  
Age: (as of June 14, 2008)  
Birthdate  
First Name:  
Last Name:  
Address:  
City:  
State:  
Zip:  
Daytime Phone:  
Email Address:  
Shirt Size:  

Parent/Guardian Information
(Required if participant is under the age of 18.  Form will be null and void without parent/guardian information)

Your Relationship To This Child:  
Parent/Guardian First Name:  
Parent/Guardian Last Name:  
Address:  
City:  
State:  
Zip:  
Daytime Phone:  
Email Address:  

Existing Medical Conditions

Does this participant have any disabilities, handicaps, present injuries or limitations, allergies, hemophilia, heart condition, history of respiratory illness or any other significant medical condition?)

      If yes, please state conditions:

BEFORE you submit your form, please make sure that all fields are complete.  Our system will time-stamp your form automatically.  Thanks for your participation in our program!  A confirmation page should appear after you click the submit button.