Participant registration

2023 Walk for Life Registration

Delaware County Pregnancy Center
Date: Saturday, April 22, 2023

Location: Chester Park Trail
172 E. Elkington Ave
Chester, PA 19013

Time: 8 am Run | 9:30 am Walk | 11 am Stroll

(Registration begins 7:30 | 9:00 | 10:30)
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

Registration begins a 7:30 AM. As a runner, you will receive a snack, be eligible for a t-shirt (raise $200 or more), and a medal if you are one of the 1st, 2nd, and 3rd place runners. If registering for more than one runner, please enter the additional name(s) below.
Runner Registration Fee $35

prevnext( X )
USDFor Runners Only
WALKING PARTICIPANT

Registration begins at 9:00 AM. As a walker, you will receive a snack, and are eligible for a t-shirt (raise $200 or more).
STROLLING PARTICIPANT

Registration begins at 10:30 AM. As a stroller with your family/friends, you will receive a snack, and are eligible for a t-shirt (raise $200 or more).
Number of participants strolling with you how many
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 2023 Walk for Life requires physical activity and there are possible risks and dangers associated with participating.I/we release the 2023 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
Should be Empty:

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2023 Walk for Life Registration

Emergency Contact

Registration

Waiver & Release