OLHSA

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Register Oakland Walk

Canterbury Village, Lake Orion

May 1, 2021

Use this form to register your immediate family members and those that you are legally allowed to sign a waiver for.

Adult Registration

Complimentary

Child Registration (17 and under)

Complimentary

I would like to donate $25 to recieve a Walk for Warmth T-Shirt (Expected ship date: April 17, 2021)

Youth Small

$25

Youth Medium

$25

Adult Small

$25

Adult Medium

$25

Adult Large

$25

Adult XL

$25

Adult 2XL

$25

Adult 3XL

$25

Adult 4XL

$25

Consider adding a donation

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Contact information

First Name

Last Name

Please don't list my name on the walk website

Mobile Number

Address

City

State

Zip

Participation Waiver

I FULLY RECOGNIZE THAT CERTAIN RISKS ARE INVOLVED WHILE PARTICIPATING IN THE OAKLAND LIVINGSTON HUMAN SERVICE AGENCY (OLHSA) WALK FOR WARMTH (“PROGRAM”) ON SATURDAY, MAY 1, 2021 AND I VOLUNTARILY ASSUME THESE RISKS. SUCH RISKS MAY INCLUDE, BUT NOT BE LIMITED TO LOSS OF MY PROPERTY OR PHYSICAL INJURY TO ME (OR MY CHILD) UP TO AND INCLUDING DEATH FROM NEGLIGENT OR INTENTIONAL ACTIONS. I AGREE THAT IF I (OR MY CHILD) INCUR ANY SUCH LOSS OF PROPERTY OR INJURY, INCLUDING DEATH, NEITHER I NOR MY FAMILY MEMBERS, NOR MY ESTATE OR HEIRS WILL HOLD TAUBMAN ASSOCIATES OR ANY OF THEIR RESPECTIVE EMPLOYEES OR AGENTS RESPONSIBLE OR SEEK DAMAGES FROM ANY OF THESE ENTITIES IN ANY FORM UNLESS THEY HAVE ACTED IN A GROSSLY NEGLIGENT MANNER OR COMMITTED AN INTENTIONAL TORT. I FURTHER UNDERSTAND THAT NONE OF THESE BUSINESSES OR PEOPLE CARRIES LIABILITY INSURANCE OR HOSPITAL OR MEDICAL PROTECTION FOR THESE PURPOSES.

DURING THE COURSE OF THE PROGRAM’S ACTIVITIES, I WILL CONDUCT MYSELF IN A PRUDENT AND CAUTIOUS MATTER AND DURING THE TIME THAT I AM INVOLVED IN THE PROGRAM, I WILL TREAT CANTERBURY VILLAGE AND ALL OTHER PERSONS USING CANTERBURY VILLAGE PREMISES IN A LAWFUL MANNER. I ATTEST TO ALL OF THE ABOVE THAT HAS BEEN WRITTEN. BY SIGNING THIS WAIVER, I CERTIFY THAT I HAVE READ AND UNDERSTAND THE ABOVE STATEMENT AND THAT MY SIGNING THIS WAIVER IS COMPLETELY VOLUNTARY.

I have read and agreed to the terms of the above waiver

Payment information

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV

I would like to cover the payment processing fee.

Make a Difference

You can make an even BIGGER difference for the people in our community by signing up to become a fundraiser and fundraising in the weeks leading up to the walk!

After you submit this form, you will be asked if you would like to become a fundraiser. You will be able to personalize your own page or join or create a team to fundraise alongside friends and colleagues.