Walk for Life Sign Up form
Saturday, August 24, 2019
Pregnancy Care Center of Randolph County
Registration: 8:30am • Walk Begins: 9:00am
Shelter #3 • Goodrich Park

Free t-shirt to the first 50 who pre-register and then either
pay $40 registration fee or else get sponsored for $40 or more.
Walkers have the option to pay through this registration form with PayPal.
Sponsors have the option to pay through the PCC's website: www.randolphpregnancy.org



WAIVER OF LIABILITY - In consideration for participating, the above mentioned, or any personal representative, shall not make any claim against, maintain an action against, or recover from Pregnancy Care Center of Randolph County for any injury, loss, damage, or death resulting from my participation in this event. Further, if the participant is under eighteen (18) years of age, on behalf of myself and any other parent or guardian of my child, I hereby release, indemnify and hold harmless Pregnancy Care Center of Randolph County from any and all liability for any loss or injury, including death, my child may suffer while participating as a result from participation in this activity. Additionally, I hereby authorize the use of my photo or likeness, regardless of media, by Pregnancy Care Center of Randolph County. *