Health Walk

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Date: Saturday June 2nd, 2018

Time: 10:30 am (Walk starts at 11:00 am)

Place: Ste-Anne Hospital site

Cost: FREE!

Come and join us at this new fundraising activity for the Ste-Anne Hospital!

A 4 km family walk in the town of Ste-Anne, followed by a picnic and outdoor activities for everyone!

SPONSORSHIP AND PRIZES

  • GREAT PRIZES for individuals with the greatest amount in sponsorship (see Pledge Form)
  • Free BBQ lunch!
  • Activities: face painting, music, games…

This event is an opportunity for the young and not so young to enjoy a family walk while contributing to the Ste-Anne Hospital Fund. All proceeds of the event will go towards the improvement of the Ste-Anne Hospital’s services and equipment.

Download your pledge form HEREHealth Walk pledge form 2018 Eng

THANK YOU to our Sponsors

 

REGISTRATION FORM

(one form per family)

Address

City

Postal Code

Telephone

Cell

Email

In case of emergency, contact

Emergency contact telephone

Register all participants:

Participant #1

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Participant #2

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #3

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #4

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #5

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #6

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #7

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #8

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #9

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Participant #10

First Name

Last Name

Birthdate (dd/mm/yyyy)

Sex

Medical problems? Medication?
Allergies? (Please specify)

Remove

Add a participant

 

 



Thank you!

Your registration has been successful.