Walk for Warmth Registration Name(Required) First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email PhoneAre you a part of a walking team? Yes No Including the person registered, how many walkers are in your group?Please enter a number from 1 to 100.2024 Pledge SheetDISCLAIMER(Required) I agree.As a WALK FOR WARMTH participant, I agree to hold Kent County Community Action and any person or employee on behalf of the agency, supporters, organizations, the County, or any of its agencies harmless for any injury, damages, or any other claims arising from my participation, and I understand the collection of donations is my responsibility (parent or guardian must sign if participant is under 18). Also, I hereby authorize Kent County Community Action (including any of their officers, employees and agents) to release, disseminate, or use in any manner they see fit, my voice, photograph and/or video as a likeness of me for the general purpose of providing education on the services provided by the agencies it administers.CAPTCHANameThis field is for validation purposes and should be left unchanged.
