Walkathon Brochure - 2021 Trifold 2
Walkathon Brochure - 2021 Trifold 2
Walkathon Brochure - 2021 Trifold 2
Name: ___________________________________________________
Phone:___________________________________Amt: $ __________
Participant Liability Agreement:
Name: ___________________________________________________
Please enter me in the “Walk to Help Children with Dyslexia”.
Phone:___________________________________Amt: $ __________
I, on behalf of myself, my heirs, executors, and administrators
hereby release the Children’s Dyslexia Centers, Inc. from any Name: ___________________________________________________
and all claims, damages, and rights of action I may have,
Phone:___________________________________Amt: $ __________
present or future, that may arise out of, or be incident to my
participation in the Walk event. In addition, I grant permission Name: ___________________________________________________
for the use of my name and/or picture in any photograph, film
Phone:___________________________________Amt: $ __________
or videotape of the event for any purpose.
Name: ___________________________________________________
________________________________________________________
Signature (parent or guardian if under 18 years of age) Phone:___________________________________Amt: $ __________
This agreement must be signed and turned in on Walk day for Total Collected: $ __________
the registration to be valid. Separate registrations for each Bake Sale and Hot Dog Roast
walker are required. (attach additional sheets if necessary) to follow