Walk For Wellness Registration/Pledge Form

Please complete the following registration/pledge form and click submit. Join Children and Nutrition Services as we help you and your children start the year off to a healthy start! On August 23rd beginning at 9 a.m. we will embark on a two mile walk.

Pedometers will be handed out by the Natrona County School District
American Red Cross will be giving out water bottles
Important immunization information will be available at a booth on the walk
A healthy and nutritious brunch will be served at the finish line

Walkers who raise $100 in pledges will be eligible to win:

Nintendo Wii

All walkers will be entered into a chance to win:

Back to School Backpack full of stationary goods

For more information please contact Jackie Immel at 266-1236 Ext. 308

Please provide the following contact information:

First Name

Last Name

Address

Work Phone

E-mail

How did you hear about our walk?

I am an:

Adult  Teen   Child

I release this organization from any liability for this event

Pledges:  Please complete the following and bring with you to the walk! Copy as needed!

Name________________________________________________________ Amount $_____

Address ___________________ Phone _______________ Town __________ State___

Name________________________________________________________ Amount $_____

Address ___________________ Phone _______________ Town __________ State___

Name________________________________________________________ Amount $_____

Address ___________________ Phone _______________ Town __________ State___

Name________________________________________________________ Amount $_____

Address ___________________ Phone _______________ Town __________ State___

Walk For Wellness Registration/Pledge Form

Children and Nutrition Services 2008 Revised: 07/08/08

Children and Nutrition Services 2008
Revised: 07/08/08