Walk Hand in Hand Family Registration Form

Hand in Hand
3860 Middle Road
Bettendorf, Iowa 52722
email us: info@handinhandqc.org

Phone: (563) 332-8010 Fax: (563) 332-7396

Family Walk Registration Form (Please fill out as completely as possible.)

Name:*

Address:*

City:*

State:*

Zip:*

Phone:*

Email:*

Please select one of the following. After you hit submit you will be directed to our paypal page where you can use your credit card or paypal account to complete your sponsorship.

Individual Registration: $20 Donation

Shirt Size: (Choose 1)
Adult: S M L XL XXL Child: XS S M L

Family Registration: $40 Donation

Shirt Size: (Please fill in the number of shirts, up to 4 total.)
Adult: S M L XL XXL Child: XS S M L

I am unable to participate. Please accept my donation supporting Hand-in-Hand:
(Hand-in-Hand is a 501© 3 non-profit organization making your contributions tax deductible.)

$10 $20 $30 $50 $100 Other $

I would like more information about Hand-in-Hand programs: Yes No

Waiver and Release of Liability I/We hereby waive all claims against Hand in Hand, Davenport Parks and Recreation, sponsors or any personnel for injury or loss I/we might suffer by participating in, or as a result of this event. I/We attest that I/we are physically fit for this event. I/We grant full permission for organizers to use photos of me/us or quotations from me/us in legitimate accounts and promotions of this event.
I Accept *

* - Mandatory Fields.

Hand-in-Hand is a non-profit organization that assists families with special needs. We exist to expand the capabilities, confidence and quality of life for children and young adults of all abilities by providing programs designed to encourage fun, learning and social interaction in a positive environment.