WTR_ Registration Form

Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Number of Guests:
Childcare Needed?
If so, for how many children?
To honor your baby during the Reading of Names, please provide their name and any details you'd like us to include.
Please submit Baby's information by 12:00pm on Thursday, 10/08/26
Baby Name for Display:
Please put N/A if you do not want this on the Reading of the Names.
Important Baby Date(s):
For the reading of the baby's names, please spell your baby's name phonetically:
Examples Here: https://www.grammarly.com/blog/writing-techniques/phonetic-spelling/
Baby's Photo:

Submit a photo to be displayed during the event. File types allowed: PNG, PDF, JPG. Important - Your photo cannot exceed the max file size of 40MB.
Cancelof
Share your story:
(Inspire others to join in the 2026 Walk to Remember. Stories will be shared on social media / our website. Please put "N/A" if you do not wish to share.)
I agree to the Media Release Policy: I hereby authorize and grant permission for Capital Area Healthy Start to use pictures taken at this event of me and any of my family, including my minor children, for the lawful use in promotional or marketing materials. I understand that no financial consideration will be offered and no further permission will be necessary.
Signature
Should be Empty:

Walk to Remember Registration Form