Prostate Cancer Awareness 3k Run/ Walk 2026 Registration

Name

This address will receive a confirmation email

Phone

Are you a Prostate Cancer Survivor?

YES NO

On behalf of the Centra Alan B. Pearson Regional Cancer Center, we would like to thank you for your participation in the Prostate Cancer Awareness 3K on September 19th, 2026 at Heritage High School hosted by Family Life Church! We are offering free prostate cancer screenings through PSA (Prostate-Specific Antigen) blood tests. Prostate cancer early detection is recommended in adults with a prostate gland starting at age 45 years (or 40 years if there are risk factors) through 75 years who might have a life expectancy of ≥10 years and who opt to participate in an early detection program. Patients are determined appropriate for PSA screening per Prostate Cancer Early Detection NCCN (National Comprehensive Cancer Network) Guidelines, 1.2025: Age 45-75 for average risk patients expected to live at least 10 or more years. Age 40-75 for Black/African American individuals, those with germline mutations that increase the risk of prostate cancer, and those with concerning family or personal health history. Age >75 should be individualized and include a discussion with your provider of the risks and benefits based on comorbidity status and estimated life expectancy. Testing after 75 years of age should be done only in very healthy people with little or no comorbidity (especially if they have never undergone PSA testing or have a rising PSA) to detect the small number of aggressive cancers that pose a significant risk if left undetected until signs develop.

Yes, I am interested in PSA screening and meet the guidelines for testing. No, I am not interested at this time.

Participant Consent Form

This Consent Form will be listed below. The consent form must be completed by the participant or participants. A parent or guardian must complete this consent form for any participant under the age of 18.

Please list all preexisting medical conditions, disabilities, allergies, or recent illnesses that may affect your participation in this event.

I consent that I am the participant. I am aware that the run/walk may have inherent and unfavorable risks of accident, personal injury, or death. I understand the nature of this activity I have chosen to take part in and accept the risks. I confirm I have a reasonable and suitable level of fitness for the run/ walk. I confirm that the information I have provided on this consent form is accurate and complete. I confirm that no one sponsoring or holding this event is responsible for any unforeseen injury to myself or by others. By completing and signing this Consent Form I confirm I have read through, understand and accepted the Terms and conditions; I am fully aware of the type of activity I will be undertaking; I consent to me and or my child's participation.

Signature

Do you have a Family Life Prostate Cancer Awareness t-shirt?

Yes, I do No, please order my free t-shirt

Size t-shirt needed

Prostate Cancer Awareness 3k Run/ Walk 2026 Registration

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