Each adult participating in the CCHS 5K Run/Walk must complete and sign their own registration form below, acknowledging the release of liability.

Parents or guardians registering a child must complete the form on the child’s behalf and provide their signature at the bottom.

A minimum registration fee each person running (adult and children) of $25.00 is required. If you are able to give more, your additional support is greatly appreciated.

The race starts at 8:00 AM on Boulevard at the Northeast Mississippi Community College campus and will weave through the Booneville, Mississippi community.

There will be a fun run at the start of the race for children.

The first 75 runners to register will receive a race T-shirt. T-shirt registration closes on April 1 to ensure printing and delivery in time for race day. Limit one T-shirt per registration.

If you have questions or need help please contact Dawn Hilliard @ dhilliard@hotmail.com. 

In consideration of being allowed to participate in the CCHS 5K Run/Walk (the “Event”) held at Northeast Mississippi Community College, I hereby acknowledge and agree to the following:

1. Acknowledgment of Risk
   I understand that participation in a run/walk event involves inherent risks, including but not limited to physical injury, falls, contact with other participants, weather conditions, traffic hazards, and other unforeseen risks. I voluntarily assume all such risks associated with my participation.
2. Release and Waiver
   I, for myself and on behalf of my heirs, executors, administrators, and assigns, hereby release, waive, and discharge Northeast Mississippi Community College, the Event organizers, volunteers, sponsors, and the benefiting nonprofit, CCHS Family Network, Inc., and their respective officers, directors, employees, agents, and representatives (collectively, the “Released Parties”), from any and all claims, demands, damages, rights of action, or causes of action arising out of or related to my participation in the Event, including any injury, illness, or loss.
3. Indemnification
   I agree to indemnify and hold harmless the Released Parties from any claims or liabilities arising from my participation in the Event.
4. Medical Certification and Emergency Care
   I certify that I am physically able to safely participate in this Event. I authorize Event officials to obtain medical treatment for me in the event of injury or emergency, and I agree to be responsible for any costs associated with such treatment.
5. Fundraising Acknowledgment
   I understand that this Event is a fundraising activity to support research, education, and advocacy related to Congenital Central Hypoventilation Syndrome (CCHS), and that my participation supports these charitable purposes.
6. Photo and Media Release
   I grant permission for the Released Parties to use photographs, video, or recordings of me taken during the Event for promotional, educational, or fundraising purposes without compensation.
7. Governing Law and Severability
   This waiver shall be governed by and interpreted in accordance with the laws of the State of Mississippi. If any portion of this waiver is found to be invalid, the remaining provisions shall remain in full force and effect.

I HAVE READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS TERMS. I SIGN IT BELOW FREELY AND VOLUNTARILY.