Hearts & Hands Walk for Autism Registration Form

Community Autism Resources
33 James Reynolds Rd
Swansea, MA 02777

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o I am unable to walk but would like to make a donation

Parent Name:

Parent Name2:

Other Name:

Other Name 2:

Other Name 3:

Other Name 4:

Other Name 5:

Other Name 6:

Other Name 7:

Other Name 8:

Address:

Email Address:

City: State: Zip:

Day phone: other phone:

Team Name: Team Captain:

How did you hear about the walk:

Liability Waiver

I understand that participation in this event is at our own risk,
We will not hold the organizers, Community Autism Resources Inc., Bristol Community College nor the City of Fall River liable for any injury, or loss/damage to property.

YES

I am part of a school’s team

Individuals who raise $60.00 or more AND who register by Thursday August 19th will receive an Official Hearts & Hands Walk T-shirt when they turn in their donations.

1 shirt per attendee please. Teams will receive for each $60.00 raised, 1 SHIRT PER WALKER when the TEAM LEADER turns in the team’s total donations.

Example: a team of 10 people will need to raise $600.00 to receive a shirt for each walker.

The deadline for those who want T-shirts is Sunday August 15^th!

We cannot guarantee shirts for those who do not register by that date.

Shirt sizes
Children’s SM MED LG

Adult sizes SM_ MED LG 1XL 2XL 3 XL

PLEASE NOTE THAT PHOTOGRAPHERS WILL BE AT THE WALK TAKING PICTURES.

PHOTOS WILL APPEAR ON THE COMMUNITY AUTISM RESOURCES’ WEBSITE.

QUESTIONS CALL 508-379-0371 EXT 16

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