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Name
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Address
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Phone Number
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E-Mail
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Raffle Tickets $2 each or 6 for $10
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Number of people registering for Buddy Walk $10.00 pp (includes shirt & lunch)
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Children shirt size (please specify size & quantity) XS 2-4, M 8-10, L 12-14
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Adult shirt size ( please specify size & quantity) S, M, L or XL
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Adult XXL or XXXL (specify size & quantity) add $2 to registration per shirt
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I can not walk but, I would like to donate $:
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Total Amount due $
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Please contact me to volunteer at the Buddy Walk:
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Yes
No
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Waiver: In consideration of me and/or my minor child being permitted to participate in the Buddy Walk, I hereby–for myself, my heirs and personal representatives–assume any and all risks which might be associated with the event. I further waive, release, discharge and covenant not to sue Down syndrome Support Group of B/CS its officers, employees, sponsors, organizers, volunteers or other representatives or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child as a result of taking part in the events and any related activities. I also authorize the use by Down syndrome Support Group of B/CS and the National Down Syndrome Society of any photo, film or videotape taken of me or my minor child at the event for any purpose.(INITIALS REQUIRED)
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Notes: (ie: mailing registration fee)
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