Register for 2nd Annual Kids Create Hope Walk

Arrive before 8:45 a.m. to avoid 9:00 a.m. State Park toll booth opening.
Participant Name:
Group/Team Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
E-mail Address:
Walking Distance:	3K 5K
Estimated Number of Participants:
Age of Participants:	Under 10 years old 10-20 years old Over 20 years old
By submitting this registration form, you agree to the following terms: I hereby waive all claims against Roswell Park Cancer Institute, the Roswell Park Alliance Foundation, Kids Create Hope and the Niagara Parks Commission, for any injury I might suffer during the Shane G. Ferguson Pediatric Cancer Research Fund - Kids Create Hope Walk for Carly's Club. I attest that I am physically able and prepared for this event. I grant full permission to organizers to use photographs of my and quotations from me in legitimate accounts and promotions for this event. I understand that all children under the age of 14 must be accompanied by a parent or legal guardian.
	I Agree

Pre-registration (received before June 1st): $5/children under 10, $10/adult, $20 family max.

Event day registration: $30/individual or family

Free T-shirt for each Pledge Sheet brought to event with $100 or more in pledges.

Proceeds benefit Carly's Club and
Roswell Park Cancer Institute