CareFirst NY

CAMPAIGN LOGO OR IMAGE

Registration

Join CareFirst for Ready, Set, Glow on Saturday, July 7th. While family friendly, due to the time of day of the event, participants are encouraged to be 12+.

Submission of this form requires acceptance of a Liability Waiver, therefore, each adult (18+) must register separately. Parents or Guardians may register themselves and their minor children on one form.

Registrant Information (18+)

First Name

Last Name

Mobile number for confirmation and updates

Email for receipt

Address

City

State

Zip

Age

T-Shirt Size (Adult)

Do you have a registration code:

Registration code:

Child 1 (Under 18)

Child 1 First Name

Child 1 Last Name

Child 1 Age

Child 1 T-Shirt Size

Child 2 (Under 18)

Child 2 First Name

Child 2 Last Name

Child 2 Age

Child 2 T-Shirt Size

Child 3 (Under 18)

Child 3 First Name

Child 3 Last Name

Child 3 Age

Child 3 T-Shirt Size

Additional Support

I would like to make an additional gift to support CareFirst in the amount of:

Waiver of Liability

I have read and agreed to the terms and conditions on behalf of myself and my minor children.

Payment information

Card Number

Expiration Date

CVV What is this?

Please don't list my registration publicly