Rock-N-Glow 5K Registration Form

Adult Name: 

Adult Shirt Size: 


1st Child's Name: 

1st Child's Age: 

Child Shirt Size: 


2nd Child's Name: 

2nd Child's Age: 

Child Shirt Size: 


3rd Child's Name: 

3rd Child's Age: 

Child Shirt Size: 


4th Child's Name: 

4th Child's Age: 

Child Shirt Size: 






Best Phone: 


Emergency Contact Name: 

Emergency Contact Number: 

By Checking This Box you agree that: CANCELLATION WAIVER: The participant acknowledges that the registration is only a license to participate in the event. There is not guarantee as to quality or any element of the scheduled event, that the scheduled event may be cancelled, shortened or altered due to weather, other acts of God, terrorism, or for any other reasons within or not within the control of Big Brothers Big Sisters of Decatur County in whole or in part, and there are no refunds for any reason whatsoever, and the registrant understands that these terms are a condition of the entry fee and agrees to register subject to these terms. WAIVER AND RELEASE OF LIABILITY: Entry invalid if not signed. By participating in the Big Brothers Big Sisters “Rock-N-Glow 5K” I for myself, all my children, my executors, administrators and assigns, do hereby release and discharge Big Brothers Big Sisters of Decatur County and all cooperating businesses and organizations from all claims of damages, demands, actions and whatsoever, in any manner arising or growing out of my partcipation, or that of all my children in this event. I agree to allow photograph(s) and brief description(s) for recruitment or public relations efforts in any way they deem necessary without remuneration or compensation, and release BBBS of Decatur County, Inc, from any and all liability, known or unknown in connection with the use of such photograph(s) and brief description(s). I certify that I, and all my children are physically able to participate in this event.


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