Please fill out this form to register. After completing the form you will be taken to a payment page where you can pay with your credit card. The registration fee is $25.00. The registration fee for seniors and youth under 12 years of age is $20.00. If you have any problems, please call the Osceola County Council on Aging at (407) 847-2144.
Personal Information:
First Name:
Last Name:
Age:
Sex: Male - Female
Address
City:
State
Zip
Home Phone:
Work Phone
E-Mail Address
Employer or School:
   
Event Information
Registration Type: Senior or Youth (Under age 12)  Standard
T-Shirt Size: S M L XL XXL
My fundraising goal is:
   
I Will Walk:
I Will Rock:
  I have my own rocking chair:
  I will need a rocking chair:
Group:
Group Name:
Group Captain:
   
Waiver Release Form:
I herby waive, release and discharge for myself, my heirs, executors, administrators, legal representatives, assigns, and successors in interest all rights and claims of any nature I (or my child if I am signing as a parent) may have or which may hereafter accrue to me agains the Council on Aging, the City of Kissimmee, and all other supporters and sponsors, their officials, agents employees, representatives, successors and assigns, which the events will be held for any and all damages which may be sustained by me (or my child if I am signing as a parent) directly or indirectly in connection with, or arising our of, my participation in or association with the event, or travel to and return from the event. I further state that I (or my child if I am signing as a parent) am in suitable athletic condition to participate in the event.
I have read the Waiver/Release Form:
Osceola Council on Aging
Barney E. Veal Center
700 Generation Point
Kissimmee, FL 34744
Phone: 407-846-8532
Fax: 407-846-8550