Walking In Healing
Sexual Assaut Awareness Walk
Registration Form
All participants 13 and older must have a completed registration form.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Age Category
*
13-18
18+
T-Shirt Size
*
Small
Medium
Large
1XL
2XL
3XL
4XL
I do not want a T-shirt
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Photo Release
*
I understand that photos and/or videos may be taken during this event and, by participating, I consent to their use for promotional and educational purposes.
Waiver & Consent
*
I understand that participation in this walk involves physical activity. I voluntarily assume all risks and release the event organizers from liability for any injury or damages.
Signature
*
Continue
Continue
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