WALK REGISTRATION

HOME CALENDAR OF EVENTS CONTACT US


Please print and use this form or email/call/write
and we will gladly provide registration forms to you

carla@aplacealongtheway.org

"9th Annual 5k Walk/Run"
for Homeless Youth

Almeria Park.
7250 Almeria Avenue
Fontana, California 92336

Suggested Registration donation:
Registration individual....................$5
Registration family..........................$10

Please note that family registration includes
One\two adults and unlimited children. Only two t-shirts
will be provided per family registration.

Additional t-shirts may be purchased for $10
each based on availability.

To pre-register, please fill out the registration
form and mail it, along with your money order payable
to APATWay or A Place Along the Way
1551 W Rialto Ave #B6., Fontana, CA 92335
Registration should be postmarked by September 15, 2016

You can also register the day of the event.

Complete one form per person (copy this form if needed)
(Please print)

Name _________________________________________________

Address_______________________________________________

City______________________State______Zip______________

Phone_________________________________________________

Corp Name_____________________________________________

E-mail address________________________________________

Check here ____ to be put on APATW mailing list

I collected pledges as:

1. An Individual ____

2. A Team Member ____

Team Name or Captain___________________

WAVIER: I hereby release the A PLACE ALONG THE WAY (APATW),
, all personnel, any
co-sponsoring organization or agency from responsibility
for any injuries or damages I may incure as a result
of my participation in “5k Walk/Run”
I assume all risks associated with this walk/run including
but not limited to falls, traffic, condition of the sidewalk
and weather conditions. I hereby certify that I am in good
condition and am able to walk/run in this event. Additionally, I
will permit the use of my picture in broadcast, print, etc.
This entry is invalid unless signed by the entrant. If entrant
is under 18, a parent or guardian must sign entry. An adult
must accompany children under 12.

_______________________________________________
Walker/runner's Signature & date (Parent/Guardian if under 18)
(one consent form per walker/runner)

“5k Walk/Run” Pledge Form

Name Address $ Amt.

1._______________________________________

2._______________________________________

3._______________________________________

4._______________________________________

5._______________________________________

6._______________________________________

7._______________________________________

8._______________________________________

9._______________________________________

10.______________________________________

11.______________________________________

12.______________________________________

13.______________________________________

14.______________________________________

15.______________________________________

16.______________________________________

Total: $_____________________

If pledges are paid after event:
PAYMENT OPTIONS-
CHECK OR MONEY ORDER:
Please print this form and
mail check or money order payable to

APATW
1551 W Rialto Ave #B6
Fontana, CA 92335

Chair: Carla Canada (909) 200-6893
Treasurer Dennis Carr.