COMPLETE THE FORM TO REGISTERPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.What is your child's Full Name? *FirstLastSelect a gender option *BoyGirlWhat is the child's Age? *What is your child's T-Shirt Size? (Youth Size) *Shirts are limited and are only available for the first 200 applicants. What is your Child's School Name? *What is your Child's Grade Level? *Parent or Legal Guardian Full Name? *FirstLastParent or Legal Guardian Address? *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent or Legal Guardian Full Name Email? *EmailConfirm EmailParent or Legal Guardian Phone Number? *CICLOVIA RELEASE AND WAIVER OF LIABILITY *By clicking this box I understand that my participation in the Ciclovia Activities is strictly voluntary and is not a requirement for me to come to the Ciclovia Event. I am aware that I should consult with a physician before I undertake any physical exercise activities. I will not, nor will anyone acting on my behalf, hold Ciclovia, or any of its partners, agencies, officers, agents, or volunteers, responsible for any injuries that might occur from my participation in the Ciclovia activity.By clicking this box, I have certified that I have read and understand the CICLOVIA RELEASE AND WAIVER OF LIABILITY Waiver. Submit LEARN MORE
