Name of Participant: *

Email Address:

Team name:

Assign me to a team. I am a walkerI am a runner

I certify that I am at least 18 years of age. *

I affirm that I have read and understand the registration information presented, and certify that in consideration of my application for participation being accepted, I agree to release Chazy Central Rural School from any and all injuries suffered by me by participating in this program. *

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