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Online Registration Form

- SRIS Community

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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Age on Race Day REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Number Please enter valid data.
- T-Shirt Size Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- WAIVER & RELEASE FROM LIABILITY
  Warning: Participation in the Rebel Run 5K can be a serious threat to the health of individuals who are not in excellent physical condition. In consideration of you receiving my application, I, intending to be legally bound, do hereby for myself and my heirs do release forever St. Romuald School, St. Romuald Church, City of Hardinsburg, and all sponsors, volunteers, and related entities from any injuries suffered in the Rebel Run 5K Road Race on October 18, 2014. I attest and verify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate. The undersigned grants full permission to any and all foregoing use to his/her likeness, including photographs, videotapes and website for publicity and advertising purposes without compensation.
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St. Romuald Interparochial School

Excellence In Catholic Education

Online Registration Form