Legacy Walkathon Registration Form

Hosted by CEWA & Friends, Inc.

Event Date: October 31, 2026 10:30am-1pm

Location: Eastern Wayne High School Track, 1135 E. New Hope Rd, Goldsboro, NC 27534

Lace up your walking shoes and help us leave a lasting legacy!

Title *

Other title *

First name *

Last name *

Age of Applicant *

Phone country code *

Phone number *

Email 1 *

Address line 1 *

City *

County/ state *

Post code *

Country *

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Relationship *

Registration Type

Legacy Walkathon Registration Type *

Pledge Information

Pledge Amount: *

Total amount enclosed

Participant Agreement and Waiver

I understand that participation in the Legacy Walkathon involves physical activity. I voluntarily participate and assume responsibility for my health and safety. I release CEWA, organizers, sponsors, volunteers, and affiliated organizations from liability for injuries, losses, or damages arising from participation, except where prohibited by law.

Participant Signature (Typed): *

Parent/Guardian Signature (if under 18) - (Typed): *

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Legacy Walkathon Registration Form

Emergency Contact

Registration Type

Pledge Information

Participant Agreement and Waiver

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