1 in 5k Registration Form

1 in 5 people will experience a sexual assault in their lifetime.

Join the Center for Health and Well-being along with the GVSU Violence Prevention Task Force as they host the 1st annual 1 in 5K on April 4, 2025 @7pm on the Allendale Campus.

Sexual Assault Awareness Month is an opportunity to listen to and honor survivors in our community. It is a time to show those who have been impacted by sexual violence that they are not alone. The funds raised from this event will go to the Survivor Support Fund which provides financial assistance to victims and survivors of sexual or intimate partner violence and stalking at GVSU, as well as funding for prevention efforts on campus. This fund is designed to support response efforts and build a future free of violence.

Who: Participants run, walk, and roll at their own pace. Strollers, wheelchairs and leashed dogs are welcome!

Where: Participants will start adjacent to the Mary Idema Pew Library entrance and finish at the Cook Carillon Tower with views of our spectacular campus.

Cost: 25.00 per person for those 17 and older. Those 16 years old and under are FREE. Please use the code YOUTH at checkout when registering those 16 yrs and younger to receive the FREE registration.

T-shirts are available with each paid registration!

* denotes a required field

Participant Information

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

I hereby declare, assert, and affirm that my participation in the Grand Valley State University Center for Health and Well-being’s 1 in 5k run, walk, and roll is done having voluntarily and knowingly assumed all risks involved in this event. The immediate physical risk(s) associated are those correlated with normal, vigorous physical activity. These risks include, but are not limited to, bodily discomfort and fatigue, muscular soreness, pulled or strained muscles, overuse injuries/soft tissue damage, bodily injury resulting from falls, and the rare instance of abnormal changes/responses of the cardiopulmonary system to exercise. Adverse responses include abnormal blood pressure, heart arrhythmias, and the very rare instance of heart attack, stroke, or sudden death.

In consideration of acceptance of this contract allowing my participation in the above stated Special Event and intending to be legally bound thereby, I hereby for myself, my heirs, executors, administrators, and assigns, WAIVE AND RELEASE any and all rights and claims for negligence, injuries, damages, or losses that I may incur involved in the above stated Center for Health and Well-being event, specifically Grand Valley State University, its respective employees, agents, representatives, successors, and assigns for any and all activities connected with the above Special Event. If I am a Grand Valley employee (faculty or staff member), I also understand that I do hereby WAIVE any and all rights or benefits under the State of Michigan Worker’s Compensation laws for any injury incurred as a result of my participation in this event.

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants

How many additional additional participants are you registering?

Additional Participants 1

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 2

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 3

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 4

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 5

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 6

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 7

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 8

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 9

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Additional Participants 10

First Name *

Last Name *

Email *

Phone Number *

Age on race day *

Emergency Contact Name *

Emergency Contact Phone *

Participation Level for this Event *

T shirt size *

Would you like to donate additional funds to the Survivor's Support Fund *

WAIVER & RELEASE OF LIABILITY

Recreation & Wellness events may be photographer or video recorded, and your attendance constitutes the consent to use the photographs and videos at our discretion.

If under 18yrs of age parent or guardian must sign for registrant.

Signature of Registrant or Parent/Guardian if under 18 *

By signing this you agree to the waiver above.

Human Verification *

Page last modified February 26, 2025

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