Walka for TACA Registration
Required Required Question(s)
1.

Please enter your information to register for Walka for TACA on April 17, 2010 at Newport Harbor High School.


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

Are you a TACA member?

Yes
No
3.

What is your relationship to autism? Please choose all that apply.

family member
grandparent
relative
professional
corporate friend
4.

How many adults will be attending?

 

  • 50 characters left.
5.

How many children will be attending?

 

  • 50 characters left.

Walka for TACA Participant Disclaimer
 
  
For the opportunity to participate in the free Walka for TACA (the “Event”), I agree as follows for myself, and for my child(ren) who participate and/or attend with me:
 
 1. I hereby waive and release, for myself, my child, executors and administrators, any and all rights, claims, liabilities and causes of action of any kind I or my child may have against Talk about Curing Autism (TACA), its affiliates and the Event operators and sponsors and each of their respective officers, directors, employees and agents relating to or arising from my or my child’s participation in the Event, including but not limited to personal injury.
 
 2. I recognize the Event has inherent risk of injury and I hereby assume that risk, and on behalf of me and my child. If I or my child causes injury to any person or damage to any property while participating in the Event, I hereby indemnify and hold harmless the Event Parties from and against any and all claims, suits, actions, loses, damages and expenses related to or arising from such injury or damage.  I am also aware I can attend the event and not participate in the activities provided. Participation in such event is optional.
 
 3. I hereby give my consent to Talk about Curing Autism (TACA) and its affiliates to use my and my child’s name and photographs, video and film (“Photos”) of me and/or my child taken the day of the Event in advertising and promotional materials for Talk about Curing Autism (TACA), including but not limited to the Internet, without compensation. I agree that no advertising or other material need be submitted to me or my child for approval. I agree that all Photos of me and/or my child used by Talk about Curing Autism (TACA) and its affiliates are owned by Talk about Curing Autism (TACA) and they may copyright material containing same. I hereby release, discharge, and agree to save harmless the Event Parties from any liability, including, without limitation, any claims for libel or invasion of publicity/privacy, by virtue of any use of my or my child’s name and/or Photos, including, any alteration of such Photos, whether intentional or otherwise.
 
 I have read and understand this Release, and declare all information is truthful and accurate.  Consent is specified below as either “I agree” or “I decline.”

 
Required 6.

Please indicate if you agree to the disclaimer above.

I agree
I decline

Thanks for registering for Walka for TACA! There's  just one more step – set up your fundraising page at www.firstgiving.com/walkafortaca.