Are you up to the challenge?
September 9, 2017

Register

2017 Pikes Peak Challenge Registration

Before registering, please review the following:
- To be qualified to hike/walk, the minimum $200 in donations, must be raised by the day of the Challenge.
- Registration deadline is September 5, 2017.
- Each participant must register individually, but if part of a team, indicate team name on registration form.
- Minimum age for the Summit Hike and Barr Camp Hike – 12 and must be accompanied by an adult.
If you would prefer to print and mail in your registration, click here for the printable registration form. Otherwise, please complete your registration by filling in the form below.
Event Information
I would like to join the*
I would like to
If you are planning on participating with a team, please select "Register as a team member" first to see if your team has already been created. If you do not see your team name listed, please change the field to "Create a team" and write in your team's name. By doing this, other members of your team who register after you will be able to select it from the list above.
Team Name
Select a team
If you do not see your team name listed, please change the field above to "Create a team" and write in your team's name. By doing this, other members of your team who register after you will be able to select it from the list above.
Are you the team captain?
- YES
Personal Information
Name*
First Last
Email*
Address*
Street Address City State ZIP Code
Home Phone*
Cell Phone
Date Of Birth*
Gender*
- Male
- Female
In order to hike at the Pikes Peak Challenge, we require that all participants be at least 12 years of age. If you would still like to participate, walking is open to all ages.
Age*
Emergency Contact Person
Name*
First Last
Relationship*
Phone*
Medical Information
Are you taking any medication?*
- No
- Yes
List medications*
Allergic to bee or wasp stings?*
- No
- Yes
How severe is your reaction and what medication will you take during the hike?*
Please check any existing medical conditions
- Asthma
- Diabetes
- Hypertension
- Pregnancy
- Seizures
- Heart Disease
- Lung Disease
Will you be participating in the walk in a wheelchair?
- No
- Yes
Please list any other conditions we should be aware of:
Additional Information
What is your connection to brain injury?*
Other:
How did the brain injury occur?
Please select the one that is most specific
Other type of brain injury
Date of brain injury:

If you don't know the eact date, that's OK. You can guess as close as you can.
Employer
T-Shirt Size*
Years Participated*
How did you hear about Pikes Peak Challenge?*
Please describe how you heard about Pikes Peak Challenge:
Military status
Promo Code
Please add me to the PPC Email Newsletter
- Yes
All PPC participants will receive a t-shirt and water bottle. For those raising more than the minimum, incentive prizes are available for different levels of fundraising. If you would like to decline an incentive prize and donate its value back to The Brain Injury Alliance of CO, please indicate below. Thank you again for all your support.
*
- Please donate the value of my prize back to the Brain Injury Alliance of Colorado
- I would like to keep any incentive prizes I earn
Terms and Conditions
In consideration for me being allowed to participate in any of the below listed Pikes Peak Challenge Events, for myself, my heirs, personal representative, next of kin and assigns hereby forever release, waive, indemnify, covenant not to sue and hold harmless the Pikes Peak Challenge, the Brain Injury Alliance of Colorado (BIAC), U.S. Forest Service, Pikes Peak Cog Railway, the City of Colorado Springs, the Town of Manitou Springs, Event Sponsors, El Paso Search And Rescue, and the above entities’ officers, directors, agents, staff members, employees, volunteers, administrators, managers, subsidiaries and all other associated persons or entities (collectively “Releasees”) from and against any and all liability, injuries, damages, claims, demands, or causes of action, which arise or may arise from my participation in the Pikes Peak Challenge Summit Hike, Barr Camp Hike and/or Manitou Walk, and subsidiary events thereof (collectively “Pikes Peak Challenge Events”), to the fullest extent permitted by law.

I acknowledge and agree that the Pikes Peak Challenge Events carry with them inherent risks associated with my participation therein, of which I am fully aware, and voluntarily assume the risks associated therewith. I recognize and acknowledge that by participating in the Pikes Peak Challenge Events I may experience potential property damage, health risks and/or bodily injuries, including but not limited to death, and voluntarily assume those risks, whether they occur or arise during or after my participation in the Pikes Peak Challenge Events.

In the event of an emergency, accident or illness, I hereby give permission to be treated by professional medical or emergency response personnel and to be transported and admitted to a medical facility, if necessary. I consent to any emergency procedure or treatment, which may, in the opinion of any medical or emergency response provider be necessary to treat my health condition or injury, including medical transportation by ambulance, helicopter or other means. I further assume responsibility, financial or otherwise, for any and all emergency medical care and transportation from the Pikes Peak Challenge Events by ambulance, helicopter or otherwise, and indemnify and hold harmless the Releasees from all liability therefore.

I hereby acknowledge that the BIAC Pikes Peak Challenge staff, its volunteers, agents, sponsors and all other parties (collectively “BIAC Staff”) involved in the Pikes Peak Challenge Events are under no obligation to provide medical care to me in the event of an accident or illness. Therefore, in the event I do receive any care, medical or otherwise, as a result of a health or medical emergency during my participation in Pikes Peak Challenge Events by BIAC Staff, I consent to such care and fully release, indemnify and hold harmless all BIAC Staff providing such care from any and all liability, whether resulting from negligence or otherwise, to the fullest extent permitted by law.

I agree and acknowledge that this Release is intended to be a broad and inclusive as permitted by the laws of the State of Colorado and that if any part of the Release is held invalid such holding shall not operate to invalidate any other provision of this Release. I agree that the forum for any claim for injuries or damages resulting from my participation in any of the Pikes Peak Challenge Events shall be in a court of competent jurisdiction in El Paso County, Colorado.

I acknowledge that during the Pikes Peak Challenge Events I may be photographed or video or audio taped. I hereby waive any rights I may have or acquire to my image or voice and grant full permission to the event organizers to use photographs, video clips, audio recordings or quotations from me in future accounts and promotions relating to BIAC events.

I warrant and represent that I am at least 18 years of age, or if I am signing this Release on behalf of someone under 18 years of age I am that person’s legal guardian and have legal authority to execute this Release on his/her behalf.

I HEREBY ACKNOWLEDGE THAT BY AGREEING TO THIS RELEASE I HAVE READ AND UNDERSTAND ALL THE TERMS CONTAINED HEREIN AND AM GIVING UP LEGAL RIGHTS THAT I OTHERWISE HAVE FOR INJURIES OR DAMAGES INCURRED DURING AND AFTER MY PARTICIPATION IN THE PIKES PEAK CHALLENGE EVENTS. I FURTHER UNDERSTAND AND ACKNOWLEDGE THAT THE TERMS OF THIS RELEASE SHALL SURVIVE THE CONCLUSION OF THE PIKES PEAK CHALLENGE EVENTS SUCH THAT I AM RELEASING THE RELEASEES FROM ALL CLAIMS THAT MIGHT ARISE AFTER THE EVENTS TAKE PLACE, WHETHER KNOWN OR UNKNOWN AT THE TIME I PARTICIPATED IN THE PIKES PEAK CHALLENGE EVENTS.

I agree to all of the terms and conditions set forth above.
*
- I agree to the terms and conditions
Payment Information
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Please enter your credit card number with no spaces, only digits.
Would you like to add $3 to your registration to cover credit card processing fees?*
- Yes, I would like to offset the CC processing fees
- No optional fee, thanks
Free Registration
Price: $0.00
Mailed in Payment
Price: $0.00
PPC20 Promo
Price: $20.00
Kids Walk Registration
Price: $0.00
Youth Walk Registration
Price: $20.00
Survivor Walk Registration
Price: $20.00
Early-bird Registration
Price: $30.00
Early-bird Walk Registration
Price: $30.00
Early-bird Registration Survivor
Price: $30.00
Regular Registration
Price: $40.00
Regular Registration Walk
Price: $40.00
Regular Registration Survivor
Price: $40.00
Late Registration
Price: $50.00
Late Registration Walk
Price: $50.00
Late Registration Survivor
Price: $50.00
Total
$0.00
Submit Registration
Please click Submit Registration only once. Processing may take a few moments, so please be patient as your transaction is completed.

After submitting, please check your email for a confirmation that includes a login for your personal fundraising page. Be sure to check junk/spam folder if you don't receive a confirmation.

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1325 S. Colorado Blvd.
Suite B300
Denver, CO 80222

QUESTIONS?

Please contact Tina Ziwak
(303) 355-9969
Tina@BIAColorado.org

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2017 Pikes Peak Challenge Registration

Event Information

Personal Information

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Medical Information

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Terms and Conditions

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