I am:

a Solo Superhero
     My name is:
    
     My solo-superhero name is/I want to be known as:
    
(Please skip to the next section - "Additional Info")

a Bounce-A-Thon Team Member
     My name is:
    
     The Team I am on is:
    
(Please skip to the next section - "Additional Info")

a Kid Walk Team Member
     My name is:
    
     The team I'm on is:
    
(Please skip to the next section - "Additional Info")

a Team Captain OR I am a Bounce-A-Thon Team Captain
     My name is:
    
     My team name is:
    
     My team members are:
     (Recommended team size is five members as team prizes are for five, but you may have a larger team!)     

First Name	Last Name

I understand each team member must fill out and sign their own registration form.


Please tell us how you heard about the Kid Walk and include the name of any Kid Walk team or team member who recruited your team:

Additional Information:

1) Please select all that describe your experience with child abuse or neglect:
I have been an abused or neglected child's caregiver.
I have been an abused or neglected child.
My relative experienced child abuse or neglect.
My friend experienced child abuse or neglect.
Other (please explain)

2) How many years have you been involved with the Kid Walk?

3) Are you interested in becoming more involved with the CASA Kid Walk next year?
I want to become a Day-of-Event volunteer.
I would like to join the Planning Committee.
Maybe, I'd like more information.
No, I'm happy with my current involvement.

4) Are you interested in becoming an advocate?
Yes, send me the application after Kid Walk.
Maybe, I'd like more info. after Kid Walk.
No, not at this time.

5) If you are currently a high school or college student, when is your expected graduation date? 

My Plan:

I'm a Team Captain (including Bounce-A-Thon teams)
My team's fundraising goal is:
($1000 is what it takes to give a child a CASA each year)

I'm a Team Member.
My personal fundraising goal is:
(10x what you are able to give yourself is a good place to start.)

I'm a Bounce-A-Thon Team Member.
My personal fundraising goal is:

I would like an online fundraising page made for each member of my team. HIGHLY RECOMMENDED! (CASA will make each page).

I would like an online fundraising page made for my team and do not want pages for each team member. (CASA will make your team page).

(Examples of online team fundraising pages from last year: Child Support CSSR, CASA'Keteers, Sweet Peas, Racing Snails )

Bio:

Why are you / your team fundraising for CASA kids? Tell us about you! How do you plan to fundraise?
(Bio appears with publicized team listings)


Walker and Runner Info (* = required field):

I am walking the:
2k walk & Champions for Children Lap.
5k walk & Champions for Children Lap.
Champions for Children Lap only.

I am running the:
2k run & Champions for Children Lap.
5k run & Champions for Children Lap.

*Last Name:

*First Name:

*Address:    

*City:            

*Zip Code:   

*Phone:         

*Email:          

*Age on Walk Day:

T-Shirt Size (for individuals raising $200 or more):

Youth Small         Medium

Youth Medium     Large

Youth Large          Extra Large

Extra Small           XXL

Small                    XXXL

I understand that fundraiser t-shirts are awarded to each individual who fundraises $200 or more.
I understand that if I reach the $200 mark after 9/21/10, my t-shirt may not be available until 11/2/10.

Waiver

In consideration of your acceptance of this entry, I hereby, for myself and my heirs, waive any and all rights and claims for damages I may have against coordinating groups and will hold them harmless for any and all injuries suffered in connection with said events. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connection with said events. I have been warned I must be in good health to participate in these events.

I accept the terms of the waiver.
I do not accept the terms of the waiver.