Challenge Race Form – Lynnwood Rotary Club

Challenge Race

Racer's Name *

First

Last

Layout

School Name *

Age *

Ages 5 & Up

Shirt Size *

Grade *

Height

Weight *

Must be 130 lbs or under

Have you been a Challenge Race "Racer" or "Co-Driver" before? *

Does the Student have a IEP or 504 Plan with their school? *

What is your favorite color?

Favorite music/artist?

Favorite activity/hobby?

Parent / Guardian's Name *

First

Last

Layout

Phone *

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

How did you hear about this event? *

Waiver and Release *

PARTICIPANT RELEASE OF LIABILITY – I understand that the above registered participant is taking part in an activity that may be hazardous for the participant. In signing below, I assume risk of harm or injury which may occur to the participant as a result of participating in the Challenge Series Race. I hereby release Life Enrichment Options, Rotary Club of Lynnwood, City of Lynnwood, sponsors, and their respective officers, volunteers, employees or agents from liability, costs and damages arising from, or occurring to, the above identified participant’s participation in the Challenge Series Race. I to participate in the Challenge Series Race and related activities. I consent to have photos/videos taken, without recompense, during the races and activities and used for publicity purpose in printed or web format.

Parent/Guardian Signature Will Be Required At The Event