2021 W4L Registration Form

2021 W4L Registration Form

Delaware County Pregnancy Center
Date: April 24, 2020
Location: The Trail @ Chester Park | 172 E Elkington Ave, Chester, PA 19013
Start Times: 8:00 AM - Runners, 9:30 AM - Walkers, and 11:00 AM - Stroll Participants
Participant Information
Full Name

First Name Last Name
Team Name
If N/A, please enter "Individual"
Fundraising Goal:
$600 is the average cost to help alleviate one client's pressures to abort and to support her commitment to bring her baby to a live birth. How many pre-born lives will you save with your fundraising goal?
Phone Number

Area Code Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
T-shirt Size

XS S M L XL XXL
Emergency Contact Details
Contact Person

First Name Last Name
Phone Number

Area Code Phone Number
Relationship
Payment Information
Method of Payment
For Runners only
Registration Fee
prev next ( X )
Runner Registration $ 35.00
Beginning at 8:00 AM. Registration includes a Snack pack-to-go for each runner, One t-shirt for each runner that raises $200 or more, and a medal for 1st, 2nd, 3rd Place. **If registering for more than one runner, please enter the names in the Additional Runner(s) field below.**

Quantity
Item subtotal: $ 0.00

Walker Registration (Each InSpirit & Track Participant) Free
Beginning at 9:30 AM. Registration includes a Snack pack-to-go for each walker and one t-shirt for each walker that raises $200 or more. **Please complete one form for each walk participant.**

Stroll Registration Free
Beginning at 11:00 AM. Registration includes a Snack pack-to-go for each stroll participant and a t-shirt for each stroll participant that raises $200 or more.

Quantity

Total $ 0.00
Additional Runner(s)
Please enter the names of the additional runners being registered.
Waiver & Release
Please check all boxes and sign. **If you are registering for more than one run or stroll participant, you are confirming the following for all participants you register.**

I confirm that I/we am/are in good shape, health, and condition. I/we don't have any medical condition or medical history that will affect my participation in this event. I/we acknowledge that the 2021 Walk for Life requires physical activity and there are possible risks and danger. I/we release the 2021 Walk for Life event organizers for any responsibility in case of an accident, illness, or injury. I/we confirm that all information in this registration form is accurate and true.
Participant's Signature

Clear
Date Signed

Month Day Year
Date
Parent/Guardian Signature (If participant is below 18 years old)

Clear
Date

Month Day Year
Date
Prizes for the most funds raised will be awarded once all sponsor donations have been tallied. Prizes will be distributed after the event. Winners will be contacted on or after April 26, 2021. The three prizes are Most Funds Raised Youth, Individual, and Team.
Should be Empty:

2021 W4L Registration Form

Participant Information

Emergency Contact Details

Payment Information

Waiver & Release