The Fort Town Night Run

Your Name *


Your Email *


Address (Street/P.O. Box, City, Province, Postal Code) *


Phone (Day) *


Phone (Evening) - if different from the Day Phone number


Emergency Contact Name & Phone Number *


I accept the waiver *
I understand and agree

Are you representing a specific group of Scouts or a community organization? *
Yes No

Please specify (e.g., 7th Prescott Scouts, SKBP Venturers, Prescott Figure Skating, Hockey Team):


Are you over the age of 18? *
Yes No

Age *


Do you require volunteer hours for school? *
Yes No

Do you have any physical restrictions that limit the type of volunteer activity you are doing? *
Yes No

Please describe:


Do you have access to a bicycle on the day of the event? *
Yes No

Do you have previous volunteer experience at a running event? *
Yes No

Please explain: