Registration – Rise Above

Areas of Participant's Interest *

Name *

First

Last

Gender *

Grade *

Ethnicity *

T-Shirt Size *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

School Name *

Is your child suffering from any known medical condition, (e.g. food allergy, asthma, heart condition) or has your child been exposed to anyone diagnosed or experiencing symptoms of COVID-19 within the last 14 days? *

Yes
No

If yes, please specify

CONFIDENTIAL: Does the participant require any special accommodations? *

Yes
No

If yes, please specify

Next-of-Kin

Please complete the information for an emergency contact.

Next-of-Kin *

Relationship to Applicant *

Next-of-Kin Cell Phone *

Next-of-Kin Home Phone *

Disclaimer

This activity/initiative is organized by Rise Above. While Rise Above takes all reasonable and necessary safety measures, Rise Above excludes all liability for any loss, damage, injuries or death that may be cause to anyone participating in the event. Rise Above follows all CDC safety measures and precautions regarding COVID-19.

Parent/Guardian’s Consent:

I consent to my child’s participation in the Rise Above activity/initiative. I hereby also certify that my child is of reasonable health to take part in this activity/initiative and will release Rise Above from all liabilities, which may arise in connection therein. I hereby grant permission for Rise Above to use photography of my child in print or online materials designed for news, informational, and/or advertising purposes.

Signature of Parent/Guardian *

Clear Signature

Name of Parent/Guardian *

Date *