Halloween Hike-a-thon 2022 Registration - Ascent Cognitive Education Center

Personal Details

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Do you have minor children that you would like to register?

Yes
No

Minor Child Registration- Maximum 3 per Registration form

You must have both physical and legal custody to register a minor for this event.

Name of Minor Child 1 *

First

Last

Do you have a second minor child that you would like to register?

Yes
No

Minor Child #2 *

First

Last

Do you have a minor third child that you would like to register? (copy)

Yes
No

Minor Child #3 *

First

Last

Emergency Contact

Name *

First

Last

Phone *

Team Information -To create a team go to: https://pages.donately.com/acec/campaign/acec-halloween-hike-a-thon-2022

Once you have registered, please click on or copy and paste the above to create your team fundraising page. Once on the page, click "Start a Fundraiser" to add your team to our Campaign. Thank you.

Are you creating a team or joining a team that already exists?

Creating
Joining

Name of the team you are creating?

Name of the team you are joining?

Is there a person that you are participating in the HIke-a-thon in honor of?

Yes
No

Their name will apear on our leaderboard page as an honorary on our website, along with your name and the name of your team.

Name of Honoree (optional)

First

Last

Voluntary Registration Donation Amount

Registration Donation Amount

First Step Level - $ 10.00
Trail Hiker Level - $ 25.00
Mountain Mover level - $ 50.00

Making a voluntary donation as a registration fee is a great way to get your team started towards their fundraising goals.

Stripe Credit Card

Card

Name on Card

Legal Consent to Participate *

Legal Waiver and Consent for Participation

2021 Ascent Cognitive Education Center Halloween Virtual Hike-a-thon Waiver By checking the box above I acknowledge that my participation in the ACEC Halloween Hike-a-thon may involve a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge Ascent Cognitive Education Center and their respective directors, officers, board of trustees, members, agents and representatives, of and from any and all liability for injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of the walk. I also agree to the use of any photo, film, video of the event, in which I may be included, for any legitimate purpose, including advertising and promotion. I further acknowledge that my signature and date at the bottom of the form denotes agreement with this clause and consent for any minors that I am legally responsible for.

Participant and Legal Gaurdian Signature *

Registration Date *

Personal Details

Minor Child Registration- Maximum 3 per Registration form

Emergency Contact

Team Information -To create a team go to: https://pages.donately.com/acec/campaign/acec-halloween-hike-a-thon-2022

Voluntary Registration Donation Amount

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