HomeLocal House Project Scholarships 1,000 Pairs of Shoes Challenge Race Community PartnersInternational Education in AfricaClub Club Leadership Past Presidents Visit A Meeting! Join Our Club! Payment Portal DACdb Login HomeLocal House Project Scholarships 1,000 Pairs of Shoes Challenge Race Community PartnersInternational Education in AfricaClub Club Leadership Past Presidents Visit A Meeting! Join Our Club! Payment Portal DACdb Login ScholarshipsChallenge RaceHouse ProjectJoin RotaryMeeting Schedule Facebook ScholarshipsChallenge RaceHouse ProjectJoin RotaryMeeting Schedule Challenge Race Racer Registration Form Please enable JavaScript in your browser to complete this form.Racer's Name *FirstLastLayoutSchool Name *Age *Ages 5 & UpShirt Size *Youth - SmallYouth - MediumYouth - LargeAdult - SmallAdult - MediumAdult - LargeAdult - X-LargeGrade *HeightWeight *Must be 130 lbs or underHave you been a Challenge Race "Racer" or "Co-Driver" before? *YesNoDoes the Student have a IEP or 504 Plan with their school? *YesNoWhat is your favorite color?Favorite music/artist?Favorite activity/hobby?Parent / Guardian InformationParent / Guardian's Name *FirstLastLayoutPhone *Email *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow did you hear about this event? *Word of MouthESD Recreation & Resource FairARCChild StriveCity of LynnwoodFamily Support CenterSnohomish County Developmental DisabilitiesLynnwood Today / MyEdmondsNews / MLT NewsRotary WebsiteSocial Media (Facebook, Twitter, etc)ESD NewsletterOtherWaiver 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 EventSubmit