CII: Active Campaign Account -

First Name *

Last Name *

Student ID# *

Phone

Southern Email Address *

Date of Birth *

Gender *

Female

Male

If you are racing for extra credit, which class are you applying this extra credit to? *

By typing my name, I agree to the written Liability Release Agreement. As a parent/guardian of a participant under age 18, I give permission for my child to participate in this event and agree to the written Liability Release Agreement. *

By submitting this form and signing up for texts, you consent to receive event updates/reminders from Child Impact International at the number provided. Consent is not a condition of registration. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP.