{{ 'SHOW_CART' | translate }} >

{{total | currency:"$"}}

{{::eventInfo.eventName}}

{{::eventInfo.when}}
{{::eventInfo.where}}

{{::eventInfo.description}}

{{ 'COUPON-APPLIED' | translate }}

{{ 'INVALID-SECONDARY-COUPON' | translate }}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'FIRST-NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'IDENT.NAME_CHARS_LONG' | translate}}

{{ 'LAST-NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'IDENT.NAME_CHARS_LONG' | translate}}

{{ 'BIRTH-DATE' | translate}}

{{ 'IDENT.RACE_AGE_BETWEEN' | translate:regOptionAgeTranslate }}

{{ 'IDENT.SERIES_RACE_AGE_ERROR' | translate }}

{{ 'REQUIRED' | translate }}

{{'REQUIRED_DATE_FORMAT' | translate:'{format: eventInfo.displayDateFormat}' }}

{{ 'GENDER' | translate}}

{{ 'REG-OPTION-GENDER-ERROR' | translate}}

{{ 'PRIMARY-PHONE' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'NOT-VALID-PHONE-NUMBER' | translate}}

{{ 'EMAIL' | translate}}

{{ 'EMAIL-CONFIRM' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'SAME-EMAIL' | translate}}

{{ 'PARTICIPANT-CONDITION' | translate}}

THE UNIVERSITY OF IOWA WAIVER AND RELEASE FORM In consideration for being permitted to participate in the Shelly Bridgewater Dreams Foundation 5K Run/Walk sponsored by the UI Department of OBGYN/Shelly Bridgewater Dreams Foundation, and to be held in Coralville, Iowa on July 8, 2017, on behalf of myself, my family, my heirs, and my assigns, I hereby release The University of Iowa; the Board of Regents, State of Iowa; the State of Iowa, The Shelly Bridgewater Dreams Foundation, and each of their respective employees, agents and representatives (Releasees) from any and all liability for personal injury, including death, or property loss or damage suffered by me as a result of, arising out of, or in any way involving my participation in this event, except to the extent that such liability results directly from the negligence of the University of Iowa or the Shelly Bridgewater Dreams Foundation, their agents, or their employees. I acknowledge that I know, understand, and appreciate the inherent risks in participating in a 5K Run/Walk. The risks may include, but are not limited to; trips/falls; potholes, debris, or other irregularities on the course; contact with other participants, strollers, wheelchairs and/or animals on the course; risks associated with vehicular traffic on or near the event route; the effect of weather including extreme temperatures, humidity, wind, and/or rain; bodily injury including, but not limited to, sprains, strains, cramps, ligament or cartilage damage, blood pressure or cardiac abnormalities; and property loss or damage. The risks include exacerbation of pre-existing medical conditions. By signing this agreement, I fully assume the inherent risks associated with this activity, and assert that I am voluntarily participating in the event, and I am at least eighteen (18) years of age* and fully competent. I grant the University of Iowa, The Shelly Bridgewater Foundation, and persons acting for or through them the right to use, reproduce, assign, and/or distribute images, audio and video recordings, and likenesses in any medium whatsoever, of myself, for the purpose of promoting the University of Iowa, The Shelly Bridgewater Foundation, or for any other lawful purpose, without payment to me. The University, its successors and assigns shall own all right, title and interest, including the copyright, to any such image, recording, or likeness. I hereby release and hold harmless the Board of Regents, State of Iowa; the University of Iowa and the State of Iowa; The Shelly Bridgewater Dreams Foundation; as well as each of their respective agents and employees from any and all claims, including but not limited to claims of infringement, damages or remuneration, for invasion of privacy, defamation, or misappropriation, or otherwise arising from such use. 
 
  • By submitting my registration, I certify that I am at least 18 years of age and fully competent. I understand and agree to all terms of the waiver and release form.I am submitting a registration for my child to participate with me.  
  • By checking this box and submitting this registration form I certify that: I am the parent/legal guardian of the participant named on this registration form; I understand and accept the risks associated with my child’s participation; I understand and agree to all terms of the above. 

{{ 'MUST-AGREE' | translate}}

{{ 'COUNTRY' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STREET' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STREET_2' | translate}}

{{ 'POSTAL-CODE' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}} {{ 'VALID-ZIP' | translate}}

{{ 'CITY' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STATE/REGION' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'RELATIONSHIP' | translate}}

{{ 'PHONE' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'NOT-VALID-PHONE-NUMBER' | translate}}

{{ 'CONTACT-CANNOT-BE-EVENT-P' | translate}}

Guaranteed to those who register prior to June 15th.

Donations to the Shelly Bridgewater Dreams Foundation (https://www.shellydreams.com/ ) are directed to our fund at the University of Iowa Foundation which directly supports our efforts to improve the health and safety of mothers and babies by promoting public awareness, educating medical professionals, funding research efforts, and supporting families affected by pregnancy-related disease.    
 
Below is the link for donating directly to the SBDF:    https://donate.givetoiowa.org/s/1773/foundation/interior.aspx?sid=1773&gid=2&pgid=509&cid=1288&bledit=1&dids=305.579&sort=1

{{ 'COUPON-APPLIED' | translate }}

{{ 'INVALID-COUPON' | translate }}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'CORRECT_ERRORS_FOR_ENTRY' | translate }}

{{ 'COMPLETE_REGISTRATION_FOR_ENTRIES' | translate}}

{{entry.name | translateIf:entry.translate}}

{{ 'EDIT' | translate }} (errors)

{{item.name | translateIf:item.translate}} :

{{item.price | currency:"$":currency.decimal}}
{{ 'SUBTOTAL' | translate}} : {{cart.subtotal | currency:"$":currency.decimal}}
{{customFee.description}} : {{customFee.price | currency:"$":currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.fee | currency:"$":currency.decimal}}
{{!cart.hasLottery ? ('TOTAL'|translate) : ('TOTAL_CHARGE_AT_CHECKOUT'|translate)}} : {{cart.total | currency:"$": currency.decimal}}

{{item.name | translateIf:item.translate}} :

{{item.price | currency:"$":currency.decimal}}
{{ 'SUBTOTAL' | translate}} : {{cart.subtotalLottery | currency:"$": currency.decimal}}
{{customFee.description}} : {{customFee.price | currency:"$": currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.lotteryFee | currency:"$": currency.decimal}}
{{ 'TOTAL_CHARGE_IF_SELECTED' | translate}} : {{cart.lotteryTotal | currency:"$": currency.decimal}}
{{ 'IF_SELECTED_CHECKOUT' | translate:cart}}

{{ 'PAYMENT-ERROR' | translate}}

{{paymentErrors.message}}

  • {{error}}
{{ 'NO-PAYMENT-REQUIRED' | translate }}

{{ 'NAME-ON-CARD' | translate }}

{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

{{ 'CARD-NUMBER' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-CREDIT-CARD-NUMBER' | translate }}

{{ 'EXPIRATION' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-EXPIRATION-DATE' | translate }}

{{ 'SECURITY-CODE' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-SECURITY-CODE' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'PAYMENT-INFORMATION-MESSAGE' | translate }}



{{crowdriseTeam.entryName}} Charity Event Fundraising on Crowdrise

{{crowdriseTeam.entryName}}: {{crowdriseTeam.msg}} (Crowdrise error)

The internet browser you are using to access this registration form is not supported. Please upgrade your browser or register on your mobile device.
Scan this QR Code with your mobile device to load the mobile registration form.
Event registration link