Monster Dash Form | Flagstaff Pediatric Dentistry

Primary Contact - add participants below

Primary First Name *

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Last Name *

Last

Email Address *

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Password *

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Confirm Password *

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Event Registration Forms

5K Run/Walk

2K Fun Run

5K Run/Walk - $25 registration fee

5K First Name *

First

Last Name *

Last

Phone

Date of Birth

Age on race day

Young Runner

I am under 12 years-old

I will accompany a Young Runner

Adult accompanying me

I will accompany this Young Runner

Emergency Contact Name

Emergency Phone Number

T-shirt Style

T-shirt Size

Event

5K Run/Walk Registration Fee: $25.00

Waiver

By checking this box, I acknowledge the event waiver.

Disability

I am disabled and require special accommodations. Please contact me.

Electronic Signature

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2K Fun Run – $20 registration fee

2K First Name *

First

Last Name *

Last

Phone

Date of Birth

Age on race day

Young Runner

I am under 12 years-old

Adult: I will accompany a Young Runner

Adult accompanying me

Emergency Contact Name

Emergency Phone Number

T-shirt Style

T-shirt Size

Event

• 2K Fun Run Registration Fee: $20.00

Waiver

By checking this box, I acknowledge the event waiver.

Disability

I am disabled and require special accommodations. Please contact me.

Electronic Signature

Clear

Add Remove

2K Discount: When you register more than 2 2K runs, any additional 2K fees will be billed at 50% off.

Final Total

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Monster Dash Registration

Primary Contact - add participants below

5K Run/Walk - $25 registration fee

2K Fun Run – $20 registration fee