Register

User Information

Name*

First Last

Email*

General Information

Gender*

Non-binary
Male
Female
Other

Other Gender Specification*

Bio*

Image

Upload File

Recommended photo size: 250 x 250.

Year*

Residence*

Event Information

What is your personal goal to raise?*

What size t-shirt do you want?*

Is there anyone you are dancing for?

Team*

Enter your new team's name*

Enter your team's nickname if applicable

Select the category or division for your team.

What is your team's goal to raise?*

Safety & Medical Information

Emergency Contact Name*

First Last

Emergency Contact Phone*

Dietary Restrictions

Vegan
Vegetarian
Gluten-Free
Dairy-Free
Other

Other Dietary Resrictions*

Agreement Information

Please read the following agreement:*

By submitting your registration form, you understand that you are voluntarily participating in this event. You also acknowledge that due to the on-going COVID-19 pandemic, the event is subject to alteration, postponement or cancellation at the discretion of the event organizers. If event details change you will be notified via the email you use to register.

As part of your registration fee, you will receive a WFU Wake 'N Shake t-shirt. Please note that exact sizing is not guaranteed and priority is given based on the time of your registration. Additionally, all shirts will need to be picked up from the Wake Forest University Reynolda Campus. Should the operating status of the University change we will not be able to mail any t-shirts. Event organizers will arrange for shirts to be collected from campus once deemed safe to do so. Instructions will be sent to you via email about how to get your shirt this year.

While participating in this event, I agree to abide by all University guidelines related to COVID-19 including mask wearing and social distancing. Specifically while dancing or engaging in activity with an elevated heart rate, I will wear a mask and maintain 10 feet of distance between myself and others.

I agree to terms and conditions written above.

Potential Donors

Please submit the contact information of friends or family members.They will automatically be sent an email telling them about Wake 'N Shake and your participation in the event, and asking if they would be willing to support you by donating to the Brian Piccolo Cancer Research Fund on your behalf

Potential Donor Name*

First Last

Potential Donor Email*

Maximum of 15 potential donors

Registration

User Information

General Information

Event Information

Safety & Medical Information

Agreement Information

Potential Donors