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AdoptWalk Family Registration Form

Please complete the fields below to submit your AdoptWalk registration form. Don't forget to download a Sponsor Pledge Form to raise funds for the walk.

Thank you for supporting NACAC!

Personal Information for Family Contact Person

First Name

Last Name

T-Shirt Size

Address
City
State
Zip
Daytime Phone Number
Evening Phone Number
E-mail Address
Additional Walkers

Walker #2
(First and Last Name)


Adult or Child (age of child )
T-Shirt Size

Walker #3
(First and Last Name)


Adult or Child (age of child )
T-Shirt Size

Walker #4
(First and Last Name)


Adult or Child (age of child )
T-Shirt Size

Walker #5
(First and Last Name)


Adult or Child (age of child )
T-Shirt Size

Walker #6
(First and Last Name)


Adult or Child (age of child )
T-Shirt Size

Walker #7
(First and Last Name)


Adult or Child (age of child )
T-Shirt Size

 

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)

African American Adoption Agency

Anoka County Parent Support Group (Deb Fjeld)

Calvary Lutheran Church (Michelle Hagelin)

CHS & LSS (Heidi Wiste)

Downeyside (Nicole McGraw)

FACAM

Family Focus Adoption (Sara Komoto)

Four's Company (Mary Sandstrom)

General Mills Adoption Connection

GIFT FAMILY SERVICES

Harambee Families Group (Helen Gallagher)

Harambee Families — Lake Elmo (Carrie Hamm)

Team Hayden (Cami Enke)

Hennepin County Adoption (Betty Woodland)

HOPE Adoption & Family Services

Jockey Person to Person

MN Adopt (Lorenzo Davis)

PATH (Tim Lorentz)

Pearl Park Parent Support Group (Nitara Frost)

Rainbow Pride (Susan Peters)

Ramsey County Youth Action Group (Karen Franklin)

Target Adoption Network (Sheila Voss)

Walling, Berg & Debele, P.A. (Stacia Driver)

Other

Fundraising Goal $
How did you hear about AdoptWalk?

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

My employer has a matching gift program:

yes   no

Employer Name

Employer Address
Employer City
Employer State
Employer Zip

 

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.

 

 

North American Council on Adoptable Children (NACAC)
970 Raymond Avenue, Suite 106
St. Paul, MN 55114
phone: 651-644-3036
fax: 651-644-9848
e-mail: info@nacac.org
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