Register Online Walk a Mile In Her Shoes (2019) Your informationWalker's Name* First Last One form per walker in each teamTeam Name (If Applicable) Your Email* Phone NumberAddress Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Men's Shoe Size (Sorry, no 1/2 sizes) Please note: Minimum registration pledge of $25.00 per Walker.Consent: Required for each participant under the age of 18 I agreePLEASE NOTE: The signature of parent/guardian is required if the Walker is under the age of 18. If the Walker is under the age of 18, we request that you download and print the registration pdf form from our website for the required signature and drop off the signed form to the CK Women's Centre prior to the event. This registration form is required to be submitted prior to the walk (as soon as possible) in order for each individual walker to be guaranteed a pair of high heeled shoes. If registration forms are not submitted prior to the walk, shoe availability can not be guaranteed. Pledges and donations for the Walk a Mile event can be submitted prior to the walk or on the date of the walk, Tuesday, October 8, 2019. Please ensure that one registration/pledge form is completed for each team member.WAIVER: Each participant must read* I agreeBy submitting this online registration form, you are acknowledging agreement that as a participant in Walk a Mile in Her Shoes, you hereby waive all claims against the Chatham Kent Women's Centre, Event Venue, Sponsors, or any personnel for any injury that you or your child might suffer at this event. You also give your full permission for any first aid that may be deemed necessary to be provided to you or your child on the premises or prior to transport to a hospital for further treatment. Furthermore, you hereby grant full permission to any and all of the foregoing to use your name and likeness in any broadcast, telecast, online, video or print media of this event without compensation.CAPTCHA
