Firecracker 5 K Race & 1 Mile Fun Run Entry Form

Please enter the information for your race entry into the form below and click on the Submit Entry Form button to submit your entry.

* indicates a required field. You must fill in all required fields in order for your entry form to be accepted.

First Name:* Last Name:*
Street Address:* City:*
State:* Zip Code:*
Phone Number:* Emergency Phone Number:*
E-Mail:
(Please see note (1) below)
Type of Entry:*
Day of race:
  • Fun Run $20
  • 5K $25
  • Wheelchair $25
Family Discount:
(Please see note (2) below)
Family Discount ($45 for four or more family members)
Family Name:
(Please see note (3) below)
Birthdate:*
Gender:*
T-Shirt Size:*
Comments:
(1) Please enter an e-mail address if possible. If you specify an e-mail address, a copy of your entry form will be sent to the e-mail address you provide.
(2) Fee payment of $45 covers families consisting of four or more persons. A registration form must be submitted for each member of the family, with the race they will be participating in specified in the Type of Entry field above. The same family name must be entered in the Family Name box below for each family member.

(3) Please enter the last name of your family if you are submitting a family entry. Please enter the same family name in the Family Name box for each family member.

T-Shirt/Packet pickup: Packets may be picked up on race day only at the registration area, beginning at 6:30 a.m.

Release from Liability and Indemnification
We wish to participate in the Firecracker 5K Race and 1 Mile Fun Run. We, individual(s) or organization, Indemnify and Hold Harmless the Lago Vista 4th of July Council, its Volunteers, and the City of Lago Vista from any and all claims, suits, losses, damages, expenses on account of the Firecracker 5K Race and 1 Mile Fun Run. Further, the noted individual(s) or organization will defend the Lago Vista 4th of July and the City of Lago Vista and its agents from all claims or bodily injury or property damage arising from their participation in the Firecracker 5K Race and 1 Mile Fun Run. We understand that we are responsible for our own safely and actions. By checking the box below, I, the individual named in the First Name and Last Name boxes above, signify that I have read this Agreement and understand and agree to all its terms.
I have read the above Release from Liability and Indemnification agreement and understand and agree to all its terms.
I agree