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AdoptWalk Individual
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. If you will be walking as a family please complete the Family Registration Form instead of this form. It will save you time by allowing you to enter all family members on one form.

Thank you for supporting NACAC!

Personal Information

First Name
Last Name

T-Shirt Size

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

 

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)

Children's Home Society & Family Services (Emily Palmer)

Downeyside (Deb Erickson)

FACAM

Family Focus Adoption (Sara Komoto)

Four's Company (Mary Sandstrom)

General Mills Adoption Connection

GIFT FAMILY SERVICES/Youth Adoption Fever

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

Team LSS (Cory Jelinek)

MN Adopt (Lorenzo Davis)

PATH (Tim Lorentz)

Pearl Park Parent Support Group (Mary McGowan)

Rainbow Pride (Mary McGowan)

Ramsey County Youth Action Group (Karen Franklin)

Target Adoption Network (Martha Hoffman)

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

I assume all risks associated with participating in this event. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my 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 my participation in this event.

I have read and agree to the above waiver.
(If you are under age 18, a parent or guardian must complete a family registration form and waiver.)

I agree to the waiver.

 

 
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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