2023 Scotty's Pound the Pavement Registration

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August 12, 2023

Participants First Name:

Participants Last Name:

Participants Age:

Race Distance: *

1/2 K (Ages 6 and younger)

2K (Ages 11 and younger)

3K (Ages 14 and younger)

What shirt size would the runner need?

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Clear selection

Participant Gender

Male

Female

Clear selection

Guardian's Name:

Phone Number:

Email:

Address

Participant's School

How did you hear about our event?

Banner or Sign

Poster

Social Media

Phone Call

TV/Raido

Bookmark from school

Other

Clear selection

I am the legal guardian of the participant. I understand that I am responsible for the child’s safety and well-being during the Scotty’s Pound the Pavement Kids Run. I know that he/she is in good health and in proper condition to participate in this event. Kids on the Block is not responsible for any accidents or injuries that may occur during this event, therefore no legal action may be filed if the child or guardian is injured. Please type your full legal name to sign.

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