Register For
Autism Alliance Walk

Registrant #1

Who are you registering? *


By selecting this box, you are indicating that you are the parent/guardian of the person you are about to register. Additionally, if the child is under the age of 13, you are consenting to the collection and use of the information about the child for the purpose of the registration as described in our privacy policy.

Have An Account?

Basic Info

To be able to access / edit your registration.

Additional Information

Format: mm/dd/yyyy
Used for age group calculations
Format: ###-###-####

Address

Choose Your Walk *

$0.00

Waiver

I understand that I am solely responsible for my health and safety, and acknowledge that I am physically capable of participating in any fundraising or awareness activity I undertake. If I am injured as a participant in an event, I agree to assume all risks, and to release and hold harmless Autism Alliance of Northeastern NY and its officers and representatives. I am aware that this is a RELEASE OF LIABILITY and a contract between me and the persons and entities mentioned above.

I agree to allow Autism Alliance of Northeastern NY the use of my name and likeness in connection with my fundraiser, for any purpose related to advertising or promotion in all forms of media.

If the participant is under 18 years of age at the time of registration, the participant's parent or legal guardian must review and agree to this Waiver and Release. The parent or legal guardian understands and consents to its terms, and authorizes the participation of the registrant by his/her acceptance below.




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