Registration

For assistance with event registration, please contact: anewleashonlife@schenectadyspca.org.

Participant Information

Participant's First Name (required)

Participant's Last Name (required)

Email (required)

Participant is over 18 years old.

YesNo

T Shirt Size
SMLXL
Street Address (required)

City (required)

State (required)

Zip(required)

Phone Number (required)

Medical Waiver

I have read and agree to the Authorization for Medical Treatment (opens new window) (required) Yes

Participant's Physician Name (required)

Participant's Physician Phone Number (required)

Emergency Contact Information

Emergency Contact Name (required)

Emergency Contact Daytime Phone Number (required)

Emergency Contact Cellphone Number (required)


I have read and agree to the Assumption of Risk and Release (opens new window)(required)
Yes