Walk to the Future, Silicon Valley

Saturday May 28, 2016 - 10am - 11am
Penetencia Creek Park, San Jose, 3050 Berryessa Rd, San Jose, CA 95132
In Conjuction with San Jose F.O.A.M. Festival Festival of Arts & Musique
Presented by Opening Doors, a  501(c)3

Walker Registration

PROPOSAL FOR REVIEW ONLY!

Join us in Penetencia Creek Park, San Jose for a fundraiser walk to raise money to fight for our youth.  Walker registration is as follows until registration closes April 34 or until the walk is full, whichever comes first.  Space is limited: Under 12 years = FREE 12 years to 17 years = $5 18 years to 62 years = $20 63+ years = $5 Note that this is a multi-step process.  You will need to fill out this Once your online registration is complete, you will be able to raise pledges online from family/friends/neighbors/coworkers/anybody you know.  Pledges raised online will be credited to your name.  On Walk Day, Saturday May 28, 2016 Parking is free. On-site registration at the Berryessa Community Center opens at 9:00 am. Walk kicks off 11 am from the the Berryessa Community Center. Walk is about 3 miles (5 kilometers). Light snacks will be available to walkers. Arrive back at the spectacular F.O.A.M. Festival about noon.  Join in the fun of F.O.A.M. Festival! Don't know how to raise money?  Believe us, it's easier than you think to raise money for causes in which you believe.  Read this website first, for hints on getting started:  http://www.regathon.com/walkforyouth/hints.htm    Then sign up below, and we will hold your hand through your fundraising journey. The Route on May 28, 2016 Penetencia Creek Park, San Jose, California

To register as a Walker, please fill out this form.  *required fields WARNING: You must have a printer connected to your computer to print out the confirmation webpage and waiver. Do not proceed if you do not have a working printer connected to your computer. *Select the school or education group for which you are raising money   Select one Any_School Opening_Doors Freds_Pets Nobel_Elementary_School_PTA Piedmont_Middle_School_PTA Pledges ou raise will be managed by Opening Doors, a 501(c)3 not-for-profit organization.  Your selected school or organization will get credit for everything you raise. YOU will also be credited for everything you raise. Walker's Name* First Name Last Name Email* Make sure this is an email address you check frequently.  You also might have to add walktothefuturesv@regathon.com to your white list so our automatic emails don't go to your spam box Enter Email Again* Cell Phone* In case we have to contact you the day of the walk.  Please include area code. Alt Phone   ext: Don't forget your area code Street Address* City* State*   AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY    Zip* Gender Male  Female Your Birthdate MM 01 02 03 04 05 06 07 08 09 10 11 12  /  DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  /  YYYY 2011 2010 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Your Age years Under 12 years = FREE 12 years to 17 years = $5 18 years to 62 years = $20 63+ years = $5 How will you be paying your walker registration fee? I will pay by Credit Card (through the Walk to the Future PayPal account - note: you do not need a PayPal account to pay by credit card.) I will mail a Check Note: All payments must be received before your registration is complete. PLEASE pay your payment as soon as you can so we don't have to spend limited staff time sending payment reminders.  Thank you! Team Name Your favorite school or education organization will be credited with pledges you raise.  But you can also walk with a team if you would like. If you are walking with a team, please type the name of the team here. If you do not yet have a team name, you can continue registering, then just ask us to add a team name later.... How did you hear about the walk?   Select one Another Organization (which one?) Case Worker Email from my Interact Club Email from Somebody Else Flier/Handbill Friend Heard At Another Shared Adventures Event Magazine Newspaper Radio (which station?) Postcard Rotary Teacher TV (which station?) Other                              Other: Have you walked in a Walk For Youth before? Yes, I have walked with Walk for Youth before No, this is my first year walking with Walk for Youth If you have a job, does your employer have a matching gift program? Yes I have a job AND my employer has a matching funds program No I don't have a job or my employer doesn't match funds If yes, please contact your employer for a matching funds application and forward it to us. If you have a job and if your employer will match donations, who is your employer? For matching funds purposes only. What is your T-Shirt size? * Men's Sizes:Small   Medium   Large   1-X  2-X Women's Sizes:Small   Medium   Large   1-X  2-X Children Sizes:2-4 6-8 10-12 14-16 Emergency Contact Info Who should we contact in case of an emergency? * Emergency Contact Name How is this person related to you? * (Mother, Father, friend, co-woker, etc) Emergency Contact Phone Number * (Please include the area code) Any other comments for the Walk For Youth Staff about any special requests, food allergies, disabilities, ideas for improving the walk?  These notes will NOT be displayed anywhere, and will only be read by the staff, so say whatever you would like.        Top of Form RELEASE OF LIABILITY - READ BEFORE SIGNING In consideration of being allowed to participate in any way in the Walk For Youth walk, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:    1.    The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2.    I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3.    I willingly agree to comply with the stated and customary terms and conditions for participation.  If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately: and, 4.    I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Walk For Youth, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. Type your full name here if you are in agreement with the liability release:  If you are under 18, have your parent or legal guardian enter their name. <-Your Full Name 18 or under requires parent/guardian name. NOTE: The person whose name appears will have to print the next confirmation webpage and sign. MEDIA RELEASE I hearby authorize and give my full consent to Walk for Youth to copyright and/or publish any and all photographs, videotapes, and/or film in which I appear while attending Walk for Youth events/activities. I further agree that Walk for Youth may transfer, or cause to be used these photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes and television programs without limitations or reservations: Type your full name here if you are in agreement with the media release.  If you are under 18, have your parent or legal guardian enter their name.   <- Full Name 18 or under requires parent/guardian name.  NOTE: The person whose name appears will have to print the next confirmation webpage and sign. Type the number below into the box below (spam prevention):    8923 -->Type that number here--> Bottom of Form Please verify that all information above is correct before you click submit. Registration cost per walker Under 6 years = FREE 7 years to 16 years = $5 17 years to 62 years = $20 63+ years = $5 If the walk should be cancelled, delayed or postponed for any reason outside the direct control of the Race Director (inclement weather; Local, State, or National emergency; or conditions on the race course), refunds will not be given, but arrangements will be made for participants to pick up their shirts and walker swag bag. Once you submit your application, you can pay by one of 3 methods. 1. Pay by logging into your PayPal account OR 2. Pay with a credit card without using a PayPal account   * After clicking below, simply fill in your information on the left side of the page.   * If you do not see fields to fill out, click the "Continue" link on the bottom left side of the page (under "Don't have a PayPal Account?"). OR 3. Pay by check. Do not continue unless you have a working printer connected to your computer. The next webpage contains a liability waiver that will have to be printed and signed. Questions? Email Walk for Youth walkforyouth@regathon.com