2009 Providence Ronald McDonald House

Walk Festival
Sunday, May 3, 2009

Registration Form

All Participants MUST Register.

REGISTERED walkers can participate in all activities including the breakfast buffet.

REGISTRATION FEES:  $20 for adults; Children, ages 6 to 14, registration fee is $5 per child; Children under 5 years free.

*Required Fields

*Name:
*Address:
*City:

*State:

*Zip:
Home Phone:

Cell Phone::
*Email:
Birthdate (month/day/year): Gender: Male Female

I am walking as an individual.
 

I am a Virtual Walk Participant

I will collect pledges in lieu of my registration fee.  I understand that I must have a minimum of $20 in pledges by May 3, 2009. ($5 for children 6-14)
I am walking as part of a team.
 Team Name:
 
 Team Leader:
 
My team is a school.
Elementary School Middle School High School College/University
My team is a business/organization.    
My team is a family.    

(other, please explain).

I am walking in honor of:
My business/organization has a matching gift program.

I am unable to walk, but wish to volunteer

I am a former guest of the House.

I am unable to walk.  Please accept my tax deductible donation of $

Make checks payable to: Providence Ronald McDonald House, 45 Gay St., Providence, RI 02905
Phone: (401) 274-4447; Fax: (401) 751-3730

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RELEASE AND WAIVER

All participants must sign the Release and Waiver. Participants under the age of 18 must have Release and Waiver signed by parent or guardian.

  In consideration of the furtherance of your purpose, objectives and work, and in consideration of your permitting me to participate in the PRMH Walk Festival, on behalf of myself and my heirs, I hereby voluntarily, knowingly, and with express intention of doing so, release and waive any and all rights and claims known and unknown, which I may have against PRMH, as well as any other persons or groups connected with this event, their heirs, assigns and successors, for any and all injuries or damages which I may suffer while taking part in this event. Additionally, I waive any right to bring suit or action against PRMH and their employees as well as other persons, or groups connected with this event, for any and all of the aforesaid injuries.

  I, the undersigned, give my general consent to the PRMH to take, reproduce and use, as described below, photographs or videotapes of me (or my minor child or ward) for use by PRMH. I understand that the photos or tapes may be taken only with the consent of the PRMH during the Walk Festival to be held on May 3, 2009, for the benefit of the PRMH Publicity Program within and outside the agency, or any other use deemed suitable by the PRMH. I hereby release and agree to hold harmless Ronald McDonald House of Providence and their duly authorized agents for all legal responsibility or liability for the use of photographs or tapes as authorized herein.

*You must check this box to signify that you have read the above information, and that a parent/guardian has also read this information if you are under the age of 18.