SRPMIC HHS Prevention & Intervention Services Glow Walk 2024
SRPMIC HHS Prevention & Intervention Services Glow Walk 2024
1.
Name (First & Last)
2.
Gender
Male
Female
Prefer not to answer
3.
Are any children participating with you? If yes, how many?
4.
How are you affiliated with the Salt River Pima-Maricopa Indian Community?
Enrolled Tribal Member
Resident of SRPMIC
Employee of SRPMIC and/or enterprises
5.
If you are a member of any other federally recognized tribe please indicate tribe:
6.
Have you participated in the Glow Walk previously?
Yes
No
7.
How did you hear about this event? (Check all that apply)
Online
Newpaper
Social Media
Work
Other
8.
You must answer yes or no:
In consideration of the acceptance of my/my child's entry I, for myself, or for my child, do hereby release and discharge the organizers of this walk and all other sponsors and organizers of all claims and damages, actions whatsoever in any manner arising out of my/my child's participation in this event. I attest and verify that I have full knowledge of the risks involved in this event and I am/my child is physically able to participate in this event. Further, I grant full permission to any and all partners of the walk to use my/my child's name, photographs, videotapes, or any other record of this event for any legitimate purpose without compensation.
Yes, I agree/consent with the above statement.
No, I do not agree/consent with the above statement and I and my child(ren) will not participate in the walk.