Participant Information
Full Name
*
First Name
Last Name
Age
*
Gender
*
M
F
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Demographics
*
Please Select
Community Partner - Adult
Community Partner - Youth
LRAC Member
Emergency Contact Details
Contact Person
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Waiver & Release
I confirm that I am in good shape, health, and condition. I don't have any medical condition or medical history that will affect my participation in this event. I acknowledge that this walk requires physical activity and there are possible risks and danger. I release the walk event organizers for any responsibility in case of an accident, illness, or injury. I confirm that all information in this registration form is accurate and true.
*
I Agree
*
I confirm that I am in good shape, health, and condition.
I don't have any medical condition or medical history that will affect my participation in this event
I acknowledge that this walk requires physical activity and there are possible risks and danger.
I release the walk event organizers for any responsibility in case of an accident, illness, or injury.
I confirm that all information in this registration form is accurate and true.
Date Signed
-
Month
-
Day
Year
Date
Submit
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