19th Annual Jerry's Run For All Ages 5K
Sat Nov 6, 2021
Adult 5k Entry (16-64):10:00 am$25.00
Youth 5k Entry (up to 15):10:00 am$20.00
80+ 5k entry:9:40 amFREE!
5k 65-79:10:00 am$20.00
BIB #

Snail mail mailing deadlines – must be postmarked by October 29, 2021. (To be guaranteed a race shirt must be postmarked by October 14).

Registration fees for 2021 for both In-Person and Virtual

(Please circle your selection)

In Person:     Adult 5k Entry (16-64)     Youth 5k Entry (up to 15)     5k 65-79     80 5k entry

Virtual:     Adult 5k Entry (16-64)     Youth 5k Entry (up to 15)     5k 65-79     80 5k entry

Mail Application to:

       Jerry’s Run For All Ages
       18 Riverview Road
      Duham, NH, 03824

  1. Snail mail for 16 to 64: $28 before 9/1 and $33 on or after 9/1

  2. Day of $35 (cash or check only)

  3. Age considerations: Age 15 & under and 65 to 79 $20 before 9/1 and $25 on or after 9/1, 80 (free)

  4. Online and Paper registration: Donation Option: “Please consider making an additional donation to support the race charities (the Wakefield Educational Foundation and the Friends of Lake Quannapowitt), as well as to support the mission of the New England 65 Plus Runners Club (the race host) to encourage running/walking/physical exercise among older individuals!

  5. No shirt option– Thanks but I do not need another race shirt! Please use the cost of the shirt as a donation to support the race charities – Wakefield Educational Foundation & the Friends of Lake Quannapowitt!

Note: Lines 1-4 are mandatory. You cannot be entered into the race if they are not complete and legible.
1First Name 
2Last Name 
3Gender   MALE      FEMALE      (please circle one)
4Age(your age on race day)

5Birthday 
6Address 
7  
8City 
9State 
10Zipcode 
11Phone 
12Email 
13Event+Long-sleeve+unisex+tech+shirt
Shirt Size
X-SmallSmallMediumLarge
X-LargeXX-LargeXXX-LargeNo Shirt - Donation
14Have you run this race before? (If yes, please indicate how many times) (If not, please tell us how you heard about our event) 
15Please give us an emergency contact name and phone 
16Are you registering for In Person or Virtual? 

Signature: __________________________________________________________ Date ____________________

Parent Signature (if under 18) ______________________________________ Date ____________________

My signature is in agreement to the following Waiver:

Waiver Must Be Read and Signed

I know that running in an event that is organized as a virtual activity where I run on my own, at a date and time of my choosing, in a location and running route of my choosing, which will not have any support or security measures in place by Jerry’s Run For All Ages 5K is a potentially hazardous activity, which could result in injury or death. I acknowledge that I am participating in the activity outlined by this virtual event by my own free will and at my own personal risk. I will not participate in a virtual event unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases, and I attest to having read the CDC’s guidance at: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html. I attest that if my community has a shelter in place order, that I will only participate in the virtual event by using a personal treadmill, and I will not run outside in the community during the duration of a shelter in place order. I agree to follow all pedestrian safety ordinances including running on a sidewalk where available and not in the road.  I agree to follow the rules of the road if no sidewalk or multi-use trail is available, and I will run against oncoming traffic and not with traffic. 

I agree to abide by any decision of a race official relative to any aspect of my participation in this virtual event, including the right of any official to deny or suspend my participation for any reason whatsoever.  I attest that I having read the rules of the virtual race scheduled for November 1, 2021 to 11:59 pm on November 6, 2021 including the terms in this waiver, the timeline of the virtual event, and agree to abide by them.  I assume all risks to me associated with running on my own as part of this virtual activity, including but not limited to: falls, contact with other pedestrians, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road or trail, all such risks being known or unknown and appreciated by me when out running on my own without any type of support from local officials or event organizers.

Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Jerry’s Run For All Ages 5K the city of Wakefield, MA, and all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this virtual event, and waive my ability to bring any legal action against the entities outlined in this waiver as I am voluntarily electing to run on my own as part of this virtual event.  I grant permission to all of the foregoing to use my photographs which I may share online as part of the event, personal data provided during registration and post-event reporting, video or audio recordings, or any other record of this event for any legitimate purpose.  I understand that this event does not provide for refunds in the event of a cancellation, and by signing this waiver, I consent that I am not entitled to a refund if the event is cancelled before or during the event.

Participant Waiver for Race Registration

I know that running/walking a road race is a potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them.  I assume all risks associated with running in this event, including but no limited to: falls, physical contact with other participants, volunteers, race personnel, contract service providers, employees, and spectators including the potential the contraction of a communicable disease resulting from contact with other participants, volunteers, race personnel, contract service providers, employees, and spectators.  I assume all risks including: the effects of the weather; high heat and/or humidity; freezing cold temperatures; traffic and the conditions of the road including surrounding terrain.  I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases, and I attest to having read the CDC’s guidance at: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html. I assume all such risks being known, appreciated, and accepted by me. 

I understand that bicycles, skateboards, baby joggers/strollers, roller skates or inline skates, animals, and personal music players are not allowed in the race, and I will abide by all race rules. Having read this waiver and knowing these facts and inconsideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Jerry’s Run For All Ages 5K, the city of Wakefield, MA, and all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  In addition, I acknowledge the contagious nature of COVID-19 and other communicable diseases and voluntarily assume the risk that I may be exposed to or infected by COVID-19 and/or other communicable diseases by participating in this event. I acknowledge that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 in connection with my participation in this event and personally assume this risk.

I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purposes.  I understand that this event does not provide for refunds in the event of a cancellation, and by signing this waiver, I consent that I am not entitled to a refund if the event is cancelled before or during the event.

Jerry’s Run For All Ages 5K does not give refunds or allow transfers of registration to a future year or another participant.