Registration Form

 

Thank you for your interest in the fifth annual Arthur Cottie Memorial - Push to End Homlessness . Please fill out the form below and you will receive confirmation of your registration as well as a link to send to your friends and colleagues to collect pledges for your “Push”. The goal is for each team to raise $1000 to sponsor one guest for one and a half months at our Inn this winter.

Please try to keep team size between four and six if possible. Other supporters may join you afterwards in Kerry Park for the BBQ portion of the event.

 

1. Please fill out your contact information
 

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Name:

 

 

 

   

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City/Province/Postal:

 

    

 

  Emergency Contact:
 

Emergency Contact Phone Number:

 

 

 


2.


3. (6 members max). $10 per member minimum donation.
Name:    
 
 
 
 
 
 


 

Participation Waiver:
In agreeing to this release, I acknowledge that I understand the intent thereof, and I hereby agree and absolve and hold harmless Inn from the Cold – Kelowna, corporate sponsors, co-operating organizations and any other parties connected with this event in any way, singly or collectively, from and against any blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained as a result of participation in this event or any activities associated therewith. I (we) give full permission for the use of my (our) name, photograph (image) and funds raised in connection with this event and I (we) understand that it may be used for publication in Inn from the Cold – Kelowna annual reports, newsletters and online.

If applicable, a parent and/or legal guardian is required to accept this waiver on behalf of a person under the age of 18.

 

*5.
Question - Required - Do you agree with the above statement?