Register by Saturday October 18th
*mandatory answer
|
* Walk Participant Type (choose one):
|
Participating in Honor of: |
Are you a member of the team?
|
Team Name:
|
* Walker Participant Name:
|
Individual with Down Syndrome's Name:
|
* Street Address:
|
* City:
* State:
* Zip Code:
|
* Email:
* Phone:
|
School:
Company:
|
Walkers:
* Number of Stroller(s) (ages 3 & under) $FREE
|
|
* Number of Walker(s) (ages 4yrs to Adult) $10.00 |
|
* Individuals with Down Syndrome $FREE |
|
2014 Buddy Walk T-shirts $5
Individuals and teams may create their own 2014 t-shirt
Or order optional 2014 Buddy Walk T-shirts $5
National Down syndrome month and World Down syndrome day commerative t-shirt
Shirt Size(s) (available while supplies last) |
Youth XS:
Youth S:
Youth M:
Youth L:
Adult S:
|
Adult M:
Adult L:
Adult XL:
Adult 2X:
Adult 3X:
|
Donation |
I wish to make a donation to DSA, Down Syndrome Alabama for amount specified $
|
Total |
Registration/Donation Total $
|
Payment Information |
Credit Card Type: |
|
Credit Card Number: |
|
Credit Card Expiration Date: |
|
First Name on Card: |
|
Last Name on Card: |
|
*Buddy Walk Participants by clicking on "I Agree," you agree, warrant and covenant as follows: 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 Alabama, The Hoover Met and The City of Hoover, their 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 Alabama of any photo, film or videotape taken of me or my minor child at the event for any purpose. |
Do Not Go Back or Re-Register if you receive an Error Message. Wait to receive an email confirmation of payment
- or - Call 205-988-0810