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Senior Concerns Love Run
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Help a Senior - Give Generously to Senior Concerns

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Love Run Online Registration

To register online:

Please enter each participant's information in the spaces provided.  For each entry, complete all the choices in each area below the participant's name. After clicking on the 'Register & Pay' link at the bottom of the form, you will be directed to Paypal. Your amount will already be calculated depending on the number of registrations you entered on the form.

After filling out the form, you will be directed to the secure, online payment system so you can enter your credit card information.

Note: Registrants can pickup their race packet beginning at 7 a.m. on the day of the race.

 
Registration Form
Team Name: (Optional)
The following information is only used to contact you about registration.
Email:
Phone: (Required)
Participant 1 (All Fields are Required)
First Name:
Last Name:
Online Waiver: I hereby release Senior Concerns, Inc. Meals on Wheel, City of Thousand Oaks, City of Westlake Village, and all municipal agencies whose property and/or personnel are used, and all sponsoring or co-sponsoring businesses or individual(s) for resposnbilitiy for any injuries or damages I may suffer as a result of my participation in the Love Run events. I hereby certify that I am in good condition and am able to safely participate in this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspaper, brochures, etc. I also understand that the entry fee is non-refundable. As a participating athlete I certify that all information provided in this form is true and complete. I hereby grant Senior Concerns permission to use my photograph in any and all publications for marketing purposes, in perpetuity. I have read the entry information provided for the event and certify my compliance by checking the box below.
I am either the person filling out this registration or this registrant's legal guardian.
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Race Type:
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Race Age:
-------------------
Shirt Size:
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Races:
Participant 2
First Name:
Last Name:
Online Waiver: I hereby release Senior Concerns, Inc. Meals on Wheel, City of Thousand Oaks, City of Westlake Village, and all municipal agencies whose property and/or personnel are used, and all sponsoring or co-sponsoring businesses or individual(s) for resposnbilitiy for any injuries or damages I may suffer as a result of my participation in the Love Run events. I hereby certify that I am in good condition and am able to safely participate in this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspaper, brochures, etc. I also understand that the entry fee is non-refundable. As a participating athlete I certify that all information provided in this form is true and complete. I hereby grant Senior Concerns permission to use my photograph in any and all publications for marketing purposes, in perpetuity. I have read the entry information provided for the event and certify my compliance by checking the box below.
I am either the person filling out this registration or this registrant's legal guardian.
-------------------
Race Type:
-------------------
Race Age:
-------------------
Shirt Size:


-------------------
Races:
Participant 3
First Name:
Last Name:
Online Waiver: I hereby release Senior Concerns, Inc. Meals on Wheel, City of Thousand Oaks, City of Westlake Village, and all municipal agencies whose property and/or personnel are used, and all sponsoring or co-sponsoring businesses or individual(s) for resposnbilitiy for any injuries or damages I may suffer as a result of my participation in the Love Run events. I hereby certify that I am in good condition and am able to safely participate in this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspaper, brochures, etc. I also understand that the entry fee is non-refundable. As a participating athlete I certify that all information provided in this form is true and complete. I hereby grant Senior Concerns permission to use my photograph in any and all publications for marketing purposes, in perpetuity. I have read the entry information provided for the event and certify my compliance by checking the box below.
I am either the person filling out this registration or this registrant's legal guardian.
-------------------
Race Type:
-------------------
Race Age:
-------------------
Shirt Size:


-------------------
Races:
Participant 4
First Name:
Last Name:
Online Waiver: I hereby release Senior Concerns, Inc. Meals on Wheel, City of Thousand Oaks, City of Westlake Village, and all municipal agencies whose property and/or personnel are used, and all sponsoring or co-sponsoring businesses or individual(s) for resposnbilitiy for any injuries or damages I may suffer as a result of my participation in the Love Run events. I hereby certify that I am in good condition and am able to safely participate in this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspaper, brochures, etc. I also understand that the entry fee is non-refundable. As a participating athlete I certify that all information provided in this form is true and complete. I hereby grant Senior Concerns permission to use my photograph in any and all publications for marketing purposes, in perpetuity. I have read the entry information provided for the event and certify my compliance by checking the box below.
I am either the person filling out this registration or this registrant's legal guardian.
-------------------
Race Type:
-------------------
Race Age:
-------------------
Shirt Size:


-------------------
Races:
Participant 5
First Name:
Last Name:
Online Waiver: I hereby release Senior Concerns, Inc. Meals on Wheel, City of Thousand Oaks, City of Westlake Village, and all municipal agencies whose property and/or personnel are used, and all sponsoring or co-sponsoring businesses or individual(s) for resposnbilitiy for any injuries or damages I may suffer as a result of my participation in the Love Run events. I hereby certify that I am in good condition and am able to safely participate in this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspaper, brochures, etc. I also understand that the entry fee is non-refundable. As a participating athlete I certify that all information provided in this form is true and complete. I hereby grant Senior Concerns permission to use my photograph in any and all publications for marketing purposes, in perpetuity. I have read the entry information provided for the event and certify my compliance by checking the box below.
I am either the person filling out this registration or this registrant's legal guardian.
-------------------
Race Type:
-------------------
Race Age:
-------------------
Shirt Size:


-------------------
Races:
Participant 6
First Name:
Last Name:
Online Waiver: I hereby release Senior Concerns, Inc. Meals on Wheel, City of Thousand Oaks, City of Westlake Village, and all municipal agencies whose property and/or personnel are used, and all sponsoring or co-sponsoring businesses or individual(s) for resposnbilitiy for any injuries or damages I may suffer as a result of my participation in the Love Run events. I hereby certify that I am in good condition and am able to safely participate in this event. I will additionally permit the use of my name and pictures in broadcasts, telecasts, newspaper, brochures, etc. I also understand that the entry fee is non-refundable. As a participating athlete I certify that all information provided in this form is true and complete. I hereby grant Senior Concerns permission to use my photograph in any and all publications for marketing purposes, in perpetuity. I have read the entry information provided for the event and certify my compliance by checking the box below.
I am either the person filling out this registration or this registrant's legal guardian.
-------------------
Race Type:
-------------------
Race Age:
-------------------
Shirt Size:


-------------------
Races:
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