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Exit Opioids 1-Mile and 5K Run/Walk Registration Form
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5K with Official Time (ages 13 and older)
5K with Official Time (ages 12 and younger)
5K WALK with no Official Time (ages 13 and older)
5K WALK with no Official Time (ages 12 and younger)
1-MI with Official Time (ages 13 and older)
1-MI with Official Time (ages 12 and younger)
1-MI WALK with no Official Time ages 13 and older)
1-MI WALK with no Official Time (ages 12 and younger)
Family of 4
Extra Family Member (more then the initial 4)
Virtual 5k with no Official Time (ages 13 and older)
Virtual 5k with no Official Time (ages 12 and younger)
Virtual 1-MI with no Official Time (ages 13 and older)
Virtual 1-MI with no Official Time (ages 12 and younger)
5K with Official Time (ages 13 and older) -
5K with Official Time (ages 12 and younger) -
5K WALK with no Official Time (ages 13 and older) -
5K WALK with no Official Time (ages 12 and younger) -
1-MI with Official Time (ages 13 and older) -
1-MI with Official Time (ages 12 and younger) -
1-MI WALK with no Official Time ages 13 and older) -
1-MI WALK with no Official Time (ages 12 and younger) -
Family of 4 -
The additional 3 prepaid family members register using Family Prepaid
As CAPTAIN you enter your personal info, your Team Name and Secret Team Code, then pay the entry fee for your team. As team CAPTAIN, you are registered. However, each team MEMBER must also register for the event.
A link for the team MEMBERS to register will be included in your CAPTAIN registration confirmation email for you to forward to your team MEMBERS. They should select the TEAM MEMBER registration category, select your team name and enter the password you have designated for the team.
If you are a parent/guardian entering several forms for each of your family/team MEMBERS, After you register yourself as CAPTAIN, then use the option to enter ANOTHER FORM for each team MEMBER you are registering.
Family Prepaid (up to 3 additional Family Members)
Extra Family Member (more then the initial 4) -
Virtual 5k with no Official Time (ages 13 and older) -
Virtual 5k with no Official Time (ages 12 and younger) -
Virtual 1-MI with no Official Time (ages 13 and older) -
Virtual 1-MI with no Official Time (ages 12 and younger) -
Setup Team Information
Team Secret Code
We will send you an email with instructions and a link to register.
You can forward this email to the members of your Team.
Participant First Name
Participant Last Name
- month -
- day -
- year -
-- select state --
District of Col.
Would you like to
receive important event text alerts
on this number (eg. changes or delays)?
Emergency Contact Name
create a new fundraising team
- select a fundraising team -
- NOT on a fundraising team -
-- select one --
Shirts are guaranteed to all those entered by September 19.
For those entering under the Family Fee option, in which event will you be participating?
5k run - timed
5K walk/run - not timed
1 mile run - timed
1 mile run - not timed
Make a Donation
(learn more about this cause)
Donation and proceeds to Exit Opioids will go towards the maintenance and development of the search platform.
WAIVER: I know that participating in a road race is a potentially hazardous activity. I should not enter and participate unless I am medically able and properly trained. I agree to abide by any decisions of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, 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 and appreciated by me. 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 the City of Raleigh, Exit Opioids, the State of North Carolina, Jim Young, Young & Associates, the Race Director, the Race Committee, the USA Track Field, and all volunteers, all sponsors, their representatives and successors from all claims or liabilities of any kind raising 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. I also agree to be contacted by the organizers or sponsors via e-mails as long as I am afforded the opportunity to opt out of future mailings. I grant permission to all of foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. I understand that bicycles, skateboards, roller skates or blades, animals and radio headsets are not allowed in the race, and I will abide by these guidelines. If, for reasons out of our control (i.e. an ice storm or such), we are unable to hold the event on the scheduled day, the race will be cancelled and not rescheduled. However, we will make all t-shirts available to those that registered. We will make every effort to run the race as long as it is safe to do so.
Read through the agreement
I have read and agreed to the waiver above
Are you 18 or older?
18 or older
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian. If registering a child under 13, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Discount, Tracking, or Charity Code
The payment and credit card section is not visible because there is nothing owed or form fields have not been fully completed.
Credit Card #
click the "pay now" button to submit your order then send a check (or pay in person) at the address above.
1. Venmo the total amount to the Phone #:
2. Make sure you enter the code,
in "What's it for".
3. Click the "pay now" button.
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