Please Note:

ONE registration must be filled out per participant.

Quantity
Price
Total
Robas Family Orchard 5K Registration
X
$
25.00=
$
0

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Emergency Contact Information

Emergency Contact Name and Phone Number*

Tech Shirt Size

Tech Shirt Size*
  • S
  • M
  • L
  • XL

Age

Age on August 12th*

Gender

Walk or Run?

Walk or Run?*
  • Walk
  • Run

Team

If so, what is the name of the team you're running with?

Submission

In consideration of the acceptance of my participation at the Ronald McDonald House Robas Family Orchard 5K Race and Fun Walk, I the undersigned, intending to be legally bound hereby, waive and release myself, my heirs, executors, and all rights and claims for damages, demands, and actions whatsoever, including negligence, which I may have against the Ronald McDonald House of Scranton, McDonald's Corporation, all sponsors, all participating volunteers and supporters and those entities, representatives, successors, and assigns, arising out of my participating at their event, including any and all injuries suffered by me as a result of my presence at this event. I certify that I am physically able to participate in this event. I authorize that the Ronald McDonald House of Scranton may use such photographs of me with our without my name and for any lawful purpose, including such purposes as publicity, illustration, advertising, and Web content.

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code