Walk for Parish Nursing – 2011 Pledge Form
Name / Address / Postal Code / Phone / Email / Amount Pledged / Amount CollectedPlease make cheques payable to CAPNM. Receipts will be issued for donations of $10 or more.
For more information please contact
Claudia McCloskey 856-3555
Walk for Parish Nursing Liability Waiver
I know that walking is a potentially hazardous activity. I should not join and walk unless I am medically able and/or cleared by a physician to do so. I assume all risks associated with walking in the walk for parish nursing including, but not limited to: falls, the effect of the weather, including high heat and/or humidity, traffic and conditions of the road/walking path, all such risks being known and appreciated by me. I, for myself and anyone entitled to act on my behalf, waive and release walk for parish nursing organizers, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this walk-a-thon though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
I further grant permission to CAPNM or ICHM to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any purpose.
(Please Print)
Participant: ______
Address: ______
Phone: ______
Email: ______
Signature: ______
(Parent or guardian signature and print name if participant is under 18 years of age.)
Where the walk is taking place:
* Walk the oval track at Crandall as little or often as you wish on Sat. afternoon, hear the birds singing. The distance will be identified on the track. You are handy the university in case you need a rest.
For refreshments afterward, come into the university for ‘Tea for Two’
.
The walk begins and ends at the same location.
The walk is wheel-chair accessible.
Walk for
Parish Nursing
Saturday, 1:30 pm June18,2011
.