First Name

T-Shirt Size

Adult S Adult M Adult L Adult XL Adult XXL Child S Child M Child L

Walker #2
(First and Last Name)

Walker #3
(First and Last Name)

Walker #4
(First and Last Name)

Walker #5
(First and Last Name)

Walker #6
(First and Last Name)

Walker #7
(First and Last Name)

General Information

If affiliated with a team, mark team's name. If you are not affiliated with a team please leave this area blank.

(Teams are listed alphabetically. Team Captain follows in parentheses.)

4Keeps Adoption Support Anoka (Julie Martindale)

Amnesty International (Daphne Quay)

CHS Kid's Time (Marian Trautmann)

FACAM (Sister Margaret Roozen)

Four's Company (Mary Sandstrom)

General Mills Adoption Connection (Carol Jackson)

Harambee Village (Deb Reisner)

Hennepin County Adoption (Jacquelin Poole/Patricia Fitzgerald)

Hope Adoption & Family Services (Sandy Zarembinski)

MARN (Jen Braun)

PATH/REACH (Tim Lorentz)

Target Adoption Network (Carrie Gorder)

Team LSS (Susan Dredge)

UJIMA Walkers (Marvaleen Atlas)

Walling, Berg & Debele, P.A. (Amanda Lieder)

Yes We Can (Brooke Bialke)

Other

Employer Matching Gift Program
If your employer has a matching gift program, please complete the fields below.

yes   no

Employer Name

Waiver

My family and I assume all risks associated with participating in this event. Having read this waiver and knowing these facts and in consideration of your accepting our entry, we, for myself and anyone entitled to act on our behalf, waive and release the North American Council on Adoptable Children, its board and staff, and all sponsors of the event, their representatives, and successors from all claims or liabilities of any kind arising out of our participation in this event.

I have read and agree to the above waiver. I am the parent/guardian of any children listed.

I agree to the waiver on behalf of myself and the other walkers listed on this form.