Registration / Pledge Form

Instructions

Please print clearly. Tax receipts will be issued for pledges of $25 or more. (Full address must be included for receipt.)

Make cheques payable to the Chris Rose Therapy Centre for Autism.

Start to collect pledges well before the walk date and bring ALL funds and the Pledge Form with you to the walk.

Additional pledge forms can be picked up at the Centre or downloaded at this link.

Name

Address

Phone

Participants under 19 #1 (Name)

Participants under 19 #1 (Date of Birth) (YYYY-MM-DD)

Participants under 19 #2 (Name)

Participants under 19 #2 (Date of Birth) (YYYY-MM-DD)

Participants under 19 #3 (Name)

Participants under 19 #3 (Date of Birth) (YYYY-MM-DD)

MUST BE AGREED TO BY EACH PARTICIPANT:
In consideration of the acceptance of this entry into the Chris Rose Walk for Autism, I, the undersigned participant, or if the participant is under 19 years of age, the parent or legal guardian of the participant, acknowledge the inherent risks associated with this event and hereby for myself, my heirs, executors, and administrators WAIVE and RELEASE any and all rights and claims for any damages of any sort I have against the Chris Rose Therapy Centre for Autism, including, but not limited to, its agents, representatives, successors, assigns, related societies or foundations and event sponsors and volunteers for any and all injuries suffered by me or damage sustained by me as a result of this event, for any cause whatsoever including negligence. I understand that this event will be photographed and videotaped and hereby give the Chris Rose Therapy Centre for Autism rights to these images for future use.
Warning:
Any participant with known and unknown physical and/or health conditions that may be aggravated by participation in this event (example: epilepsy, heart conditions, etc.) should check with his/her physician before entering. Neither the Organizers nor the Sponsors are responsible for pre-event screening of participants and/or injuries incurred during the event.

I have read the above waiver in full understanding. Parent or legal guardian must sign if participant is under 19 years of age. Please type your name below to sign.

There is a minimum $10.00 pledge per participant to receive a T-shirt. T-shirts must be picked up at the Centre as we cannot ship them. For those who will be taking part in the walk outside Kamloops, we would love to see pictures of your walk and the fun you have had — please tag us on social media through our Facebook, Twitter and Instagram pages!

There is no charge to participate in the walk itself, but we welcome donations and pledges. All fund raised stay in our community to support individuals with autism spectrum disorder

Other Details

Once you submit the registration, it will take you to a confirmation page where you will be able to see the information that is being sent to us. Thank you so much for being part of this amazing event!