2nd Annual Opal Lee Juneteenth Walk Sign Up Form
Walk Date:
June 15th 2024
Location:
Plano City Hall, 17 E. Main Street
Registration Time:
10:00 AM
Participant Information
Full Name
First Name
Last Name
Age
Date
-
Month
-
Day
Year
Date
Gender
Please Select
M
F
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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 short walk requires some physical activity.
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.
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
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