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Read and agree to the waiver to continue (NOTE: special section at conclusion regarding participation of a minor.)
I know that participation in the Miles & Memories 5K is a potentially hazardous activity and that I should not enter unless I am medically able and properly trained. I understand and appreciate all of the risks associated with this event - including but not limited to: falls, contact with other participants, effects of weather, traffic, and road conditions. Having read and understood this waiver, I hereby waive and release, for myself and for my heirs and assigns, any and all claims, causes of action, or liabilities which may hereafter accrue against Great River Health Systems, Two Rivers Financial Group, the City of West Burlington, their affiliates, agents, employees, volunteers, officers, directors, successors and assigns, and any and all sponsors, their representatives and successors, that may arise as a result of my participation in the Miles & Memories 5K, including any and all claims for personal injuries caused by negligence. In exchange for consideration received, I hereby give permission to Miles & Memories 5K run/walk to use my name and photographic likeness in all forms and media for advertising, trade, and any other lawful purposes.  
This section to be read and signed by parent/legal guardian if Participant is a minor: As the parent/legal guardian of the above-named Participant, I hereby waive and release on behalf of my child, any and all claims, causes of action, or liabilities which may hereafter accrue against Great River Health Systems, Two Rivers Financial Group, the City of West Burlington, their affiliates, agents, employees, volunteers, officers, directors, successors and assigns, and any and all sponsors, their representatives and successors, by reason of my child’s participation in the Miles & Memories 5K, including any and all claims for personal injuries caused by negligence. In addition, I accept full responsibility for the care and supervision of my child during the above-described run. 
 

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  • A long-sleeve t-shirt is guaranteed to each participant who registers before September 18. Size selection is final.

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Select Your Complimentary Long-Sleeve T-Shirt Size

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$125: Includes Your Loved One's Name on Back of Event Shirt and a Complimentary Shirt

Click to view sample

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If you wish to have a photo printed on your flag please email a jpeg file to grmilesandmemories@gmail.com with the orders name and contact info. List any text below you'd like to include on your flag:
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You may pick up your flag on Oct. 5th after the run/walk. Or you can pick up your flag at the Great River Hospice office (1306 S. Washington Road, West Burlington) starting Monday, Oct. 7th through the end of the month. The office is open 8 a.m. to 4:30 p.m. Monday through Friday.

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If you wish to have a photo printed on your flag please email a jpeg file to grmilesandmemories@gmail.com with the orders name and contact info. List any text below you'd like to include on your flag (30 characters per line includes spaces):
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You may pick up your flag on November 3rd after the run/walk. Or you can pick up your flag at the Great River Hospice office (1306 S. Washington Road, West Burlington) starting Monday, Nov. 6th through the end of the month. The office is open 8 a.m. to 4:30 p.m. Monday through Friday.

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If you wish to have a photo printed on your flag please email a jpeg file to grmilesandmemories@gmail.com with the orders name and contact info. List any text below you'd like to include on your flag:
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You may pick up your flag on Oct. 5th after the run/walk. Or you can pick up your flag at the Great River Hospice office (1306 S. Washington Road, West Burlington) starting Monday, Oct. 7th through the end of the month. The office is open 8 a.m. to 4:30 p.m. Monday through Friday.

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