NAMI of Lake County

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone

Are you a Walker or Sponsoring a Walker or Team?*

Register a Team

If you are registering a team, list your team name here.

Walker or Team Name

Please provide us with the walker's name or Team you are sponsoring so that we may credit your donation.

Age of Walker*

Adult
Child (under 18)

Suggested Donation*

Custom Donation Amount

Waiver*

By signing your name in the above space you acknowledge and consent to the following: Waiver of Release and Liability: In consideration of being permitted to participate in Strides for Awareness NAMI Lake County, I hereby for myself, my heirs, and my personal representatives assume any and all risks that might be associated with the event. I further waive, release, discharge, and covenant not to sue NAMI Lake County, its officers, employees, sponsors, organizers, volunteers or other representatives or agents or their successors and assigns for any and all injuries or damages of any kind whatsoever suffered as a result of me and/or my child taking part in the event and any related activities. I also agree to the use of any photo, film or videotape of the event for any purpose. I also give my full permission for such first aid as deemed necessary to be provided to me or my child on the premises or prior to transport to a hospital for further treatment.

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