Jordan's Walk & Roll Registration

2017 Registration
( click here to download a printable registration form)

To guarantee a t-shirt please register by May 13, 2017

* Indicates required field

Registration Type *

Participant Name *

First

Last

T-Shirt Size *

Email *

If registering as a family, enter each additional participant below.

Participant #2 (Family Registration Only) *

First

Last

T-Shirt Size (Participant #2) *

Participant #3 (Family Registration Only) *

First

Last

T-Shirt Size (Participant #3) *

Participant #4 (Family Registration Only) *

First

Last

T-Shirt Size (Participant #4) *

Participant #5 (Family Registration Only) *

First

Last

Participant #6 (Family Registration Only) *

First

Last

T-Shirt Size (Participant #5) *

T-Shirt Size (Participant #6) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Consent & Liability Waiver
Hold Harmless: By participating in the Walk & Roll, I agree to release and hold harmless Living Loud, Inc., its officers, directors, employees, and agents, St. Norbert College and the City of De Pere, from any and all liability, losses, claims, actions, costs, including attorney fees resulting from injury to person or damage to property arising out of my participating in the Walk & Roll. Photograph Authorization: I hereby give Living Loud, Inc. and its affiliates, permission to photograph me during the run and its related activities, and to use those photographs for any purpose. Eligibility Certification: I certify that I am eligible to attend this event. As a participant in the Walk & Roll, I understand I may become ill or injured and medical treatment may be necessary. I give consent to Living Loud, Inc.’s medical staff and/or volunteers to evaluate, treat injuries/illnesses, and activate emergency care as indicated.

Agreement Required *

By checking this box I agree to the Consent & Liability Waiver for myself and all other participants named above

NOTE: After submitting your registration form, follow the prompt to pay for your registration via Paypal. Your registration will not be complete until payment is received. If you do not want to use PayPal that is perfectly fine! After you have submitted the registration form simply mail a check to:
Living Loud, Inc. , 1248 Franco Ct. De Pere, WI 54115

Submit Registration

After submitting your registration form, complete the registration process by selecting the appropriate amount below and submitting your payment via Paypal.