On your mark, get set!

Adult Hurdler *

First Name

Last Name

Young Hurdler #1 *

First Name

Last Name

Young Hurdler #2

First Name

Last Name

Young Hurdler #3

First Name

Last Name

Phone

(###)

###

####

Parental Consent *

I herby grant permission to Hurdles In Heels to use the image of the participant. Such use includes but is not limited to: the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of the participant for use in materials that may include, but not exclusive to printed materials such as brochures newsletters, videos, and digital images such as those on the Hurdles In Heels Web site.