Walking Club Registration

How old are you?

Participant Details

First Name

Middle

Last Name

Suffix

Birthdate

Cell Phone

The following demographic questions are optional and are to help us evaluate the reach of our programs.

Zip Code

Gender

Race/Ethnicity

Parent/Guardian Contact Information

Parent/Guardian First Name

Middle

Parent/Guardian Last Name

Suffix

Cell Phone

Preferred contact method

Phone call	Text
Email

I verify that I am the parent or guardian of the participant and give consent to participate in Sabathani Community Center's programming.

I confirm

Add a second parent or guardian for this participant

Second Parent/Guardian Contact Information

Second Parent/Guardian First Name

Middle

Second Parent/Guardian Last Name

Suffix

Second Parent/Guardian Cell Phone

Second Parent/Guardian Email

Preferred contact method

Phone call	Text
Email

Waiver

In consideration of my (and/or my child's) participation in this activity, I hereby release and discharge Sabathani Community Center, and its representatives, successors, and assigns, from any and all liability arising from accident, injury, and illness that I (he/she/they) may suffer as a result of my (our) participation in this activity.

Initial that you have read and agree to the above waiver.

Photo/Video Agreement

I grant the Sabathani Community Center (SCC) and anyone authorized by SCC to use my and/or my child's photographic images, video and audio with or without my and/or my child's name in SCC promotional materials.

Initial that you have read and agree to the above release.

Did you know that Sabathani Community Center offers many programs? Select any programs or services below that you would like to learn more about, so we can connect you (or your family) with the right people.

Food Access	Clothing Closet	Affordable Housing
Senior Programs	Workforce Strategies	Youth Programs