Walk/Run/Ride Registration Form
Sign-up page for the Rock Around the Block June 23, 2018
Email address *
First Name *
Your answer
Last Name *
Your answer
Gender *
Walk, Run or Ride *
Age Group *
Contact Info
Address *
Your answer
Address line 2
Your answer
City *
Your answer
State *
Your answer
Your answer
Primary Phone *
Your answer
Alternate Phone
Your answer
Which number would you like us to send text messages to?
Every participant will receive a red Rock Around the Block shirt.
T-Shirt Style *
T-Shirt Size
Waiver: I know that running a road race is a potentially hazardous activity, which could cause injury or death. I should not enter and run unless I am medically able and properly trained, and by my signature below, I certify that I am medically able to perform this event, am in good health, and am properly trained. I agree to abide by any decision of a race official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with running in this event, including, but not limited to, the following: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic, and the conditions of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby joggers, roller skates or blades, animals, and radio headsets are not allowed in the race, and I will abide by this guideline. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Friends of Lone Rock School, The Town of Orange, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
I understand the waiver *
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