Save the Date! BellRinger Weekend 2025 — October 24-25

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Take Part
- Overview
- Ride
- Volunteer
- Build A Team
- Virtual Ride
Impact
Community
Shop
Resonance

Register
Donate

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High School Student Registration

BellRinger is a bike ride and community movement to end cancer with Georgetown University’s Lombardi Comprehensive Cancer Center. Join us as a student Rider or volunteer for our fourth annual Ride on October 25, 2025! Fill out this quick form and we’ll get you squared away.

How would you like to participate? *

Rider
Volunteer

Student Rider

Student Volunteer

How far do you plan to Ride? *

25 Miles — Washington, D.C. to Gaithersburg, MD — ages 14+
I commit to raise $500 for cancer research
50 Miles — Washington, D.C. to Gaithersburg, MD — ages 14+
I commit to raise $625 for cancer research
62 Miles — Washington, D.C. to Gaithersburg, MD — ages 16+
I commit to raise $750 for cancer research
100 Miles — Washington, D.C. to Gaithersburg, MD — ages 16+
I commit to raise $750 for cancer research

Rider: Personal Information

What is your email address? *

Name *

First

Last

Phone Number *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Birthdate *

Gender *

Man
Woman
Non-Binary
Prefer Not to Answer

Unisex Apparel Size *

Gender-Specific Apparel Size *

Rider Type

I am a Survivor
I am a Cancer Researcher

Adult Rider

All minor Riders (ages 14-17) need to be accompanied by an adult during the Ride. Please include the information of your adult Rider below. Please note, all adult Riders must additionally complete their own registration at BellRinger.org/Register.

Adult Rider Name *

First

Last

Adult Rider Email *

Adult Rider Phone Number *

Relationship *

Is your Adult Rider the same as your emergency contact?

Yes
No

Emergency Contact

Emergency Contact Name *

First

Last

Relationship *

Emergency Contact Phone Number *

What Team would you like to join

Participant Waiver, Release of Liability, & Assumption of Risk *

Legal guardian has carefully read this Participant Waiver, Release of Liability, & Assumption of Risk. I understand and agree to the terms laid out in the Participant Waiver, Release of Liability, & Assumption of Risk.

Volunteer Participant Waiver, Release of Liability, & Assumption of Risk (copy) *

Legal guardian has carefully read this Volunteer Participant Waiver, Release of Liability, & Assumption of Risk. I understand and agree to the terms laid out in the Volunteer Participant Waiver, Release of Liability, & Assumption of Risk.

Student fundraising commitment *

I understand my student fundraising commitment must be met by 11:59 PM on October 22, 2025. My fundraising commitment is considered satisfied when the “funds raised” number on my Rider Profile page on the BellRinger website meets or exceeds my selected fundraising commitment.

I understand in the event I fall short of my fundraising commitment, I will not be eligible to attend the Opening Ceremony and will not be eligible to participate in the Ride. *

I understand in the event I fall short of my fundraising commitment, I will not be eligible to attend the Opening Ceremony and will not be eligible to participate in the Ride.

Legal Guardian *

First

Last

As the Guardian, I have read, understand, and accept the Minor Student Participant Waiver. By typing my name above, I acknowledge that I am providing a valid electronic signature.

Legal Gaurdian Phone Number *

Legal Guardian Email *

100% of funds raised support

Academic Health System Partner

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Name

First

Last

Email Address *

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