Footsteps of Our Ancestors Walking Pilgrimage Registration

Footsteps of Our Ancestors Walking Pilgrimage – Registration Form

Saturday, June 13, 2026
Please note: This form collects information to help pilgrimage organizers plan for a safe and successful event. Please answer all required questions accurately.
Adult Participant / Parent or Legal Guardian Information

Please provide details for the primary registrant (required).
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Logistics

Help us plan for meals and transportation.
Will you be staying for lunch after the pilgrimage?
Any dietary restrictions?
Will you be riding the bus back to Mocanaqua at the end of the pilgrimage?
Participant under age 18

Let us know if you are registering any participants under 18.
Will you be registering any participants under the age of 18?
Minor Participant Information

Please list each minor participant if applicable.
Please list the full name(s) and age(s) of all participants under 18:
All participants under 18 must be accompanied by a parent or legal guardian at all times.
Parental Consent and Assumption of Risk: By registering minor participants, I certify that I am the parent or legal guardian and consent to their participation. I understand and accept all risks associated with this event on their behalf.
Emergency Contact Information

In case of emergency, please provide a contact we can reach.
Emergency Contact Name
Relationship to Participant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any medical concerns or dietary restrictions the organizers should be aware of?
Participant Requirements

Please confirm your ability to participate.
I acknowledge that I am physically able to walk seven miles on public roads and designated trails.
Assumption of Risk and Release of Liability: I understand that participating in the pilgrimage involves inherent risks including, but not limited to, slips, trips, falls, uneven surfaces, inclement weather, fatigue, dehydration, and vehicular traffic. I agree to release and hold harmless Footsteps of Our Ancestors, its organizers and volunteers, and the Commonwealth of Pennsylvania, Department of Conservation and Natural Resources, except for gross negligence or willful misconduct.
I have read and agree to the Assumption of Risk and Release of Liability.
Photo/Communications Consent: I grant permission for photographs and communications from this event to be used for promotional and informational purposes.
Signature and Affirmation

Please type your full name as your electronic signature.
Electronic Signature (type your full name)
I affirm that all information provided is accurate to the best of my knowledge.
Should be Empty:

Footsteps of Our Ancestors Walking Pilgrimage – Registration Form

Adult Participant / Parent or Legal Guardian Information

Event Logistics

Participant under age 18

Minor Participant Information

Emergency Contact Information

Participant Requirements

Signature and Affirmation