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» Breast Cancer Awareness Walk
KCCHSD Breast Cancer Awareness Walk
Thanks to all who came out for this one... It was a HUGE success!!
Burlington Community Center - 340 South 14th Street
We can't wait until this time NEXT YEAR!!
A BIG Thanks goes out to all of our sponsors!
if you would like to be a sponsor in this year's Breast Cancer Awareness Walk
if you would like to view our flyer!
to view the 2018 Breast Cancer Awareness Walk Guide!!
Each participant must have a completed Release form completed. If you are paying for multiple people, please print this form and have each participant fully completed it. If a participant is under the age of 18, a Legal Authority of Parent or Legal Representative must sign the paper version for the Release form. Forms must be collected before the walk. Forms can be mailed or dropped off to Hillary Dwyer or Admissions at Kit Carson County Memorial Hospital, 286 16th Street Burlington, CO 80807.
If you are over the age of 18 and sign the form below electronically, you do not need to sign a paper form.
Breast Cancer Awareness Walk
Credit Card Number:
Card Security Code (CSC)
T-Shirt for person completing the form: Child/Adult
T-Shirt Size: (Children's only come in Small-Large)
If you are paying for more than one person please list their names below followed by their shirt size. They will receive an adult t-shirt unless otherwise noted.
Team's Name (optional):
If you were referred by a KCCHSD employee, please list their name:
By electronically signing this box, I acknowledge that I have read and understood the following release and waiver and agree to its terms
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