Registration Form

Please complete the following registration form to receive your Username and Password to access our online registration system to register for the Couch Potato 5K/1K.

This form will not enroll you for the Couch Potato 5K/1K.
Click the Submit By E-mail button to e-mail the form to our office.

Participant Information

Last Name (Required)

First Name (Required)

Date of Birth (Required)

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Gender (Required)

Male
Female

Age (on 5/22) (Required)

Address

Street Address (Required)

City (Required)

State

Zip (Required)

Contact Information

Home Phone (Required)

Work Phone

Cell Phone

E-mail Address (Required)

Release, Waiver of Liability and Covenant Not to Sue

In consideration of my acceptance of this entry, for myself, my heirs, executors and administrators, I do hereby waive liability, release and forever discharge the City of Bowling Green, the Toledo Roadrunners Club, their employees, agents and officials, and all related parties, their demands, rights and causes of action of whatever kind or nature, arising out of all known and unknown, foreseen and unforeseen, bodily and personal injuries, damages to property, and the consequences thereof, including death resulting from my voluntary participation in, or in any way connected with, such recreational programs and athletic activities.

Release, Waiver of Liability and Covenant Not to Sue (Required)

By checking this box, I (parent/guardian if under the age of 18) agree to the terms and conditions in the statement above and verify that all information is correct.

Today's Date

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Click the Submit By E-mail button to e-mail the form to our office and we will e-mail your Username and Password to register online for the Couch Potato 5K/1K.

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