Participant registration

Walk for Life 2025 Registration

Please fill out the registration form below to participate in our annual walk for life event.
Date: Saturday, April 26th, 2025

Location: The Stage @ Chester Park
172 E. Elkington Ave
Chester, PA 19013

Participant Times:

9 am Runners | 10 am Walkers & Strollers
Participant Name*

First NameLast Name
Team*
If N/A please enter Individual
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Contact Number
Fundraising Goal
T-shirt Size (choose one)

XXLXLLMSXS
Emergency Contact

Please enter the name and number of your emergency contact in case of an emergency.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship
Registration

Please choose how you will participate.
RUNNING PARTICIPANT

Running participants will begin at 9:00 AM. As a runner, you will receive a snack, and are eligible for a t-shirt (raise $200 or more).
WALKING PARTICIPANT

Walking participants will be begin at 10:00 AM. As a walker, you will receive a snack, and are eligible for a t-shirt (raise $200 or more).
STROLLING PARTICIPANT

Strolling participants will begin at 10:00 AM. As a stroller with your family/friends, you will receive a snack, and are eligible for a t-shirt (raise $200 or more).
Waiver & Release
Please check all boxes and sign below. If you are registering for more than one run/walk/stroll participant, you are confirming the following for all involved.*

I/we confirm that I am/we are in good shape, health, and condition to participate in this event.I/we do not have a medical condition or history that will affect my/our participation in this event.I/we acknowledge that the DCPC 2025 Walk for Life requires physical activity and there are possible risks and dangers associated with participating.I/we release the 2025 DCPC Walk for Life event organizers from any responsibility for an accident, injury, or illness that may occur during my participation in this event.I/we confirm that all information supplied in this registration form is accurate and true.
If participant is a minor, check the box below.

I am signing as guardian for the registered minor participant.
Participant's Signature (or Guardian Signature, if applicable)*

Clear
Date Signed*

MonthDayYear
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Name

First NameLast Name
Email
example@example.com
Should be Empty:

Walk for Life 2025 Registration

Emergency Contact

Registration

Waiver & Release

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