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Ovarian Cancer TealBlazers Mid-Week Walk Event Registration Form

Ovarian Cancer TealBlazers Mid-Week Walk Event • September 23, 2026 • 6:00 PM • William Byrd Park - Richmond, VA

"*" indicates required fields

Name*
Date of Birth*
If Registrant is under the age of 18, an adult must fill out this form on behalf of the Registrant.
Address*
Are you an Ovarian Cancer Survivor/Patient?*
Would you like to make a donation?
Proceeds will go to the Team Kimlee Jewel Fund to benefit ovarian cancer survivors/patients.
Credit Card
Waiver Agreement for Registrant*
I know that running, walking, or volunteering for a road race is a potentially hazardous activity. I will not enter and run and/or walk unless I am medically able and properly trained. I agree to abide by any decision of a road race official relative to my ability to safely complete the run and/or walk, but I understand that I am primarily responsible for my own safety. I assume all risks associated with participating in this event, including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat or humidity, traffic and the conditions of the road, and potential exposure to communicable disease (including but not limited to coronavirus/COVID-19, other viruses, bacteria, and all other infectious pathogens and disease vectors) all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Team Kimlee, Team Kimlee Ovarian Cancer Run/Walk Club, Ovarian Cancer TealBlazers, the City of Richmond, and all other potential sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I understand that this is an informal event.
Name of Registrant or Parent/Guardian if Registrant is under 18 years of age.
Today's Date*
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