The Fort Town Night Run

Parent/Guardian's Full Name *


Parent/Guardian's full address (number, street, city/town, ON, Postal Code) *


Parent/Guardian's Home Phone *


Parent Guardian's Cellular Phone


Your Email *


Youth's Full Name *


Date of Birth (DD-MM-YY) *


Health Concerns (Please list all, including Allergies, Asthma, Learning Difficulties, Medications, Diseases and Disorders) *


Any Accomodations needed


I have read the Participant Conduct and agree *

I have read the Assumption of Risk and Waiver of Liability and agree *

I have read the Acknowledgement of Understanding and agree *