Jiggly Piggly Registration Form

First Name*
Last Name*
Address*
Street Address City State ZIP Code
Age*
- Under 21
- Over 21 (ID will be required at check-in)
Contact Numbr*
Emergency Contact Name*
First Last
Emergency Contact Contact Phone*
Email*
T-Shirt Size*
- Small
- Medium
- Large
- X-Large
- XX-Large
- XXX-Large
Wavier*
- I Agree
I acknowledge that my participation in the Jiggly Piggly Food Run involves a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge Uptown Lexington Inc. and their respective directors, officers, employees, affiliates, members, agents, and representatives, of and from any and all liability, losses or damages, incurred by me in connection with any aspect of the food run.
Registration Fee*
Price:
Total
$0.00
Comments
This field is for validation purposes and should be left unchanged.