Survived to Live Women in Transition: Walk A Thon Registration

Survived to Live for Women in Recovery: Walk-A-Thon Participant Registration
Location: Dwayne Browder Field: 5077 Outhwaite Ave, Cleveland, OH 44104

Date: Saturday, July 19th, 2025

Time: 10:00AM - 12:00PM
Participant Details
Date Signed

MonthDayYear
Date
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Age*

Child (up to 17 years old)Young Adult (18 - 26)Adult (27 - 64)Senior (65 years and older)
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person

First NameLast Name
Emergency Person Phone Number

Area CodePhone Number
Relationship to Emergency Contact Person
T-shirt Size

XSSMLXLXXL
Registration Payments

Payments will be accepted at the event. Electronic payments only NO CASH
Payment Method
Registration Fee
prevnext( X )
Adult Walker$10.00

Quantity

Child$ Free

Quantity

Adult Sponsor Registration$10.00
Interested in paying it forward for someone else to attend? Sponsor someone else to attend by paying additional registration fees.

Quantity

In-Kind Donation$ Free
Not available to attend but still interested in supporting? Feel free to provide a donation!

Total $0.00
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 will follow the rule and regulations of the event.I release the event organizers for any responsibility in case of an accident, illness, or injury.I allow my photo to be taken during the event and used for event advertising and marketing.I confirm that all information in this registration form is accurate and true.
Participant's Signature
Parent/Guardian Signature (If participant is below 18 years old)
Should be Empty:

Survived to Live for Women in Recovery: Walk-A-Thon Participant Registration

Participant Details

Registration Payments

Waiver & Release