Community Walk-a-Thon Against Child Abuse Form
First Day of Walking:
April 15th 2023
Location:
Anywhere
Last Day of Walking:
May 18th 2024
Participant Information
Full Name
First Name
Last Name
Age
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Profile Picture
Browse Files
Cancel
of
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
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 confirm that all information in this registration form is accurate and true.
Participant's Signature
Date Signed
-
Month
-
Day
Year
Date
Parent/Guardian Signature (If participant is below 18 years old)
Date
-
Month
-
Day
Year
Date
Submit
Submit
Print Form
Should be Empty: