3rd Annual Stroll-a-Thon

Registration Form

Name                                                                                                                     

Address                                                                                                               

City                                                                                                                        

State/Zip                                                                                                               

Phone                                                      Age                        Sex                        

E-mail                                                                                                                    

(1) $20 - fee prior to the event, or(2) $25 - fee on April 19, or(3) $10 off if donating a stroller for an Alpha client - any time

Sorry - no refunds in case of rain  -- Please note: $5 discount each when groups of 5 or more register together

Total Enclosed $                 

_____ Cash

_____ Check (made payable to ALPHA)

Waiver of Responsibility

I understand that my registration fee is non-refundable.  In signing this release I acknowledge that I understand the intent of this event and hereby agree and will absolve and hold harmless Alpha Pregnancy Counseling & Support, SLO Parks and Recreation, sponsor organizations, and any other parties connected with this event in way from and against any blame and liability for any injury misadventure, harm, loss or damage suffered as a result of participation.  I also hereby give permission for the uses of any emergency treatment in the event of injury or illness.

                                                                                                Date                        

Signature of Participant

                                                                                                Date                        

Signature of Adult or Guardian (if participant is a minor)

Contact Alpha at (805) 541-3367 with any questions. Thank you for supporting our work in the community!

Alpha Stroll-a-Thon Sponsor Donation Sheet

Sponsor’s Name                      Address                                     City                                    Phone                          Amount

                                 _______                                                                                                                                          $