Registration Registration
Form Form
Down Syndrome Awareness Group
11th ANNUAL BUDDY WALK
October 29, 2011 8:00am to 2:00pm
Healing Place Church
19202 Highland Road
Baton Rouge, LA
**FREE ADMISSION**
We will be serving jambalaya, and enjoying family and friends, music, fun, and
games! We will also have t-shirts and other items for sale
PRE-REGISTRATION DEADLINE: Saturday, October 15, 2011
On-site registration will also be available beginning at 8:00am on October 29th.
Name(s)
Address
Home:
Phone
Cell:
E-Mail Address
In consideration of me and/or my minor child(ren) being permitted to participate in all
Buddy Walk activities, I hereby for heirs, my personal representatives, and myself
assume any and all risks, which might be associated with the event. I further waive,
release, discharge and convenant not to sue the National Down Syndrome Society, the
Down Syndrome Awareness Group (DSAG), their officers, sponsors, organizers,
Waiver volunteers, or other representatives or their successors and assigns, for any and all
injuries or damages of any kind whatsoever suffered by myself and/or my minor
child(ren) as a result of taking part in the Buddy Walk event and related activities. I also
authorize and release DSAG to use any photo, film, or videotape taking of me or my
minor child(ren) at the event for any purpose and by signing, authorize such use and
acknowledge DSAG’s ownership of same.
THIS REGISTRATION FORM IS NOT VALID UNLESS SIGNED BY ALL ADULTS REGISTERING.
Date:
Signature(s)
Date:
T-SHIRT ORDER
($10 each - - all sizes. Indicate number of shirts desired in each size.)
6 Month 12 Month 18 Month
Infant
2T 3T 4T
Youth S M L
S M L
Adult
XL XXL XXXL
TOTAL AMOUNT
T-Shirt Total: ______ @ $10.00 each $
Donation $
TOTAL $
Make checks payable to: DSAG (Down Syndrome Awareness Group)
Mail form and t-shirt payment to:
DSAG
PO Box 82378
Baton Rouge, LA 70884
For more information, send email to: buddywalk@dsagbr.org
Or visit our website at: www.dsagbr.org
*** EVENT WILL BE HELD RAIN OR SHINE***
***YOU MAY DUPLICATE THIS FORM FOR OTHER FAMILY AND FRIENDS***