PRAYER WALK REGISTRATION FORM

First & Last Name *

Email *

Phone Number *

Which city are you registering for? *

Are you bringing a group? *

Yes No

How many people are in your group?

What church do you attend?

Are you on medication that must be taken at specific times throughout the day? (For awareness in case of emergency) *

Yes No

Will you require assistance during the walk? (e.g., mobility assistance; helps plan logistics like transportation) *

Yes No

"I agree to participate at my own risk and release the organizing entity from liability for injuries.” *

Yes

To sign the waiver type your full name below *

Do you authorize your email to be used for local community news and announcements? *

Yes No

Do you authorize your phone number to be used to contact you in regards to the event that you are registering for? *

Yes

Please check the box below to receive a copy of your registration form (HIGHLY RECOMMENDED)

YES, EMAIL COPY OF REGISTRATION

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