Event Form

Name*

PrefixFirst NameLast Name
Email*
example@example.com
Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Post Code
Date of birth*

MonthDayYear
Date
T-shirt size*

XSSMLXLXXL
Height*
Weight*
Place information*

Get a Claire House Charity placeI have bought/am buying my own place
Are you fundraising in connection to a Family we support?*

YesNo
Message*
Video upload

To complete your application, please upload a 60‑second video telling us why you would like to run for Claire House. Your video helps us get to know you and understand your motivation for supporting local seriously ill children.

By submitting your video, you agree that Claire House may use it for future promotional purposes if your application is successful.
Video Upload*

Cancelof
Event ID
Attendee type
Should be Empty: