5K Fun Run-Walk
The Town of Halifax, Halifax Farmers Market, and the Healthy Harvest Community Garden will host a 5K Fun Run-Walk on Saturday, May 7th at the Halifax Farmers Market. Start time will be 9:00 am. Registration forms may be dropped off at the Halifax Town Hall, 70 South Main St., Halifax, or the Extension Office, 171 South Main St..
The first 30 participants to register will receive a free pedometer!
For more information, contact Maria Traynham @ 434-476-2147 or This email address is being protected from spambots. You need JavaScript enabled to view it. or
Denise Barksdale @ 434-476-2343 or This email address is being protected from spambots. You need JavaScript enabled to view it.
Participant Information
Name: ___________________________________________
Address: _________________________________________
Phone: ___________________________________________
Gender: _______ Age: ______ Race: ______
Emergency Contact
Name: _______________________________ Phone: ______________________
Relationship to participant: __________________________
Waiver and signature required on back!
5K Fun Run-Walk Waiver
Not all exercises are suitable for everyone. It is recommended that you consult with your physician before beginning any exercise program. You should understand that when participating in any exercise or exercise program, there is the possibility of physical injury. If at any point during your workout you begin to feel faint, dizzy, or have physical discomfort you should stop immediately. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge the Town of Halifax, Halifax Marketplace & Farmers Market, Healthy Harvest Community Garden, and all employees or volunteers of the agencies from all claims or causes of action.
By signing below, you give the Town of Halifax, Halifax Marketplace & Farmers Market and Healthy Harvest Community Garden permission and consent to take photographs or videos of you during this event without expectation of payment. You further give permission and consent that any such media may be used in promotional materials, websites, social media, and shared with other entities.
Signature of Participant: _________________________________ Date: _____________
This section to be signed by parent/legal guardian if participant is a minor:
As the parent/legal guardian for the above-named participant, I hereby agree that the Town of Halifax, Halifax Marketplace & Farmers Market and Healthy Harvest Community Garden, all employees of the above-mentioned agencies or volunteers are not responsible or liable for any accidents or claims that may arise as a result of my child’s participation in the Healthy Harvest Community Garden 5K Fun Run-Walk.
Signature of Parent/Legal Guardian: ________________________ Date: ____________
