I would like to register as a Walker for this event.

 

 

Walker Name

 

Team Name (if applicable):

 I would like to donate (only) to this event.

Sponsor's Name (if applicable):

I am parent/guardian of walker

Donation Type (if applicable) (Select) On-Line Mail-In

Donation Amount (if applicable)

Print & fill out the registration form, have parent/guardian sign the waiver, and mail to:

Pat Rosen, Kids Helping Kids, Care House, 44765 Woodward Avenue, Pontiac, MI 48341

Please also fill out the following information and submit:

First Name		Last Name
Address		City
State		Zip
Phone		E-Mail