Wall Build 2023 Registration

Name

This address will receive a confirmation email

Phone

Address

By checking the box, I, and all members of my family participating in this event, do hereby grant and convey to Lithopolis United Methodist Church and Habitat for Humanity, all right, title and interest in any and all photographic images, video and audio made by Lithopolis United Methodist Church and Habitat for Humanity during participation in activities identified by or related to this form. Furthermore, I, for myself and on behalf of my estate, heirs, executors and administrators do hereby fully release and discharge Habitat for Humanity, from any and all liabilities, claims, obligations, damages and causes of action whatsoever arising or growing out of participation in the programs of Habitat for Humanity . I also understand that I am responsible for all medical bills related to such activity, that I am serving at my own risk and that Habitat for Humanity is not liable in the event of sickness, injury, accident, theft, or death. By checking the box likewise indicates that I have read this entire document, understand it completely and agree to the conditions and terms stated herein.

I agree

Signature

Today's Date

Area of Service

Area I'd like to serve

Crew Leader (9am-noon) Crew Member (9am-noon) Children's Activities (9am-noon) Loading & Standing Walls (11am-approx. 3pm, must be 16 or older) Food Prep (Friday, April 21 10am-2pm at LUMC)

Comments

Family Members

Spouse's Name

Area Spouse would like to serve Crew Leader (9am-noon) Crew Member (9am-noon) Children's Activities (9am-noon) Loading & Standing Walls (11am-approx. 3pm, must be 16 or older) Food Prep (Friday, April 21 10am-2pm at LUMC)

Child #1 Name

Child #2 Name

Child #3 Name

Child #4 Name

Activities for children age 3+ will be available from 9am-lunchtime at the Workforce Center. Children will also be encouraged to participate in building the walls. There will be stations that are specifically designated for families with younger children. Please list the names and ages of children who will be taking part in the additional activities being provided.

Dietary Restrictions:

Donations

LUMC has pledged to give $10,000 towards the supplies required to build our Habitat for Humanity home. If you'd like to help us reach that goal, you're welcome to make a donation.

Payment

Amount

Shirts

Please note, the deadline for ordering shirts is Sunday, April 2. Anyone registering after that date is still welcome to join us, but unfortunately, will not receive a shirt. Please indicate the size and quantity of shirts your famiy would like below:

Adult 3XL

Adult 2XL

Adult XL

Adult L

Adult M

Adult S

Youth L

Youth M

Youth S

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Wall Build 2023 Registration

Description

Please Fix the Following