Community Walk Registration

	**Required Field*
First Name:	*
Last Name:	*
Street:	*
City:	*
State:	*
Zip:	*
Phone Number:
Email:
Walked last year?
Freihofer employee?

If you are NOT planning to walk for a specific non-profit organization, please select "INDIVIDUAL" here.
INDIVIDUAL Contact: N/A Phone: N/A Code: 199

If you are planning to walk for a specific non-profit organization, please select from the organization list below. This list is updated frequently, please check back if your organization doesn't yet appear.
Organization List

	Organization ID: 296 Organization Name: 100 Hispanic Women, Inc., Capital District Chapter Contact: Denise Pallozzi Phone: 683-0923 Code: 296
	Organization ID: 321 Organization Name: Alight Pregnancy Center Contact: Michelle Waldron Phone: 822-9008 Code: 321
	Organization ID: 322 Organization Name: Angel Names Association Contact: Michelle Mosca Phone: 654-2411 Code: 322
	Organization ID: 204 Organization Name: Big Brothers Big Sisters of the Capital Region Inc Contact: Beth Hart Phone: 862-1250 x 21 Code: 204
	Organization ID: 97 Organization Name: Brain Injury Association of New York State Contact: Rachel Swire Phone: 459-7911 Code: 97
	Organization ID: 243 Organization Name: Capital City Rescue Mission Contact: Sue Jones/Doreen Welch Phone: 462-0421 Code: 243
	Organization ID: 323 Organization Name: Clear View Center Contact: Steve Kroft Phone: 435-9931 x 227 Code: 323
	Organization ID: 27 Organization Name: Conserns-U Contact: Colleen Pidgeon Phone: 463-8571 Code: 27
	Organization ID: 324 Organization Name: Duanesburg Area Community Center Contact: Susan Kamiler Phone: 895-9500 Code: 324
	Organization ID: 29 Organization Name: Early Childhood Education Center Contact: Dona Wildove Phone: 456-3268 Code: 29
	Organization ID: 320 Organization Name: Grand Street Community Arts Contact: Jennifer Simek Phone: 463-2222 Code: 320
	Organization ID: 94 Organization Name: Hostelling International/Hudson-Mohawk Contact: Brian Logan Phone: 437-1802 x 240 Code: 94
	Organization ID: 326 Organization Name: Joan Nicole Prince Home Contact: Patricia Cuda Nicolella Phone: 346-5471 Code: 326
	Organization ID: 302 Organization Name: Juvenile Diabetes Research Foundation Contact: Susanne Keller Phone: 477-2873 Code: 302
	Organization ID: 312 Organization Name: Our Own Productions, Inc Contact: Susan Eliashuk Phone: 356-2306 Code: 312
	Organization ID: 57 Organization Name: Park Playhouse II Contact: Shirley Arensberg Phone: 330-6201 Code: 57
	Organization ID: 325 Organization Name: Regional Food Bank of Northeastern New York Contact: Tracey Martin Phone: 786-3691 x 227 Code: 325
	Organization ID: 63 Organization Name: Ronald McDonald House Charities Contact: Tina Woodward Phone: 438-2655 Code: 63
	Organization ID: 306 Organization Name: Senior Services of Albany Contact: Donna Vancavage Phone: 463-4381 Code: 306
	Organization ID: 84 Organization Name: St Catherine's Center for Children Contact: Joan Bender Phone: 453-6700 Code: 84
	Organization ID: 327 Organization Name: Stakeholders Foundation, The Contact: Justin Priddle Phone: 708-6350 Code: 327
	Organization ID: 77 Organization Name: Wildwood Programs Inc Contact: Becky Thayer Phone: 429-3732 Code: 77

WAIVER AND RELEASE OF LIABILITY
In consideration of the acceptance of my entry, I, on behalf of myself,my heirs, executors, administrators and assignees, hereby release myself and discharge: the Charles Freihofer Baking Company, Inc., George Weston Bakeries, Inc., the Office of General Services, State of New York, Albany County, the City of Albany, the Adirondack Association and USA Track and Field and all other sponsors or beneficiaries and their representatives, successors and assignees from any and all claims of damages and cause of action arising from or out of my participation in the Freihofer's Community Walk. I attest that I am physically fit and that my condition has been verified by a physician. I am aware that the medical support for this event will be volunteer medical personnel who will be prepared to administer first aid only. I hereby grant permission to the Charles Freihofer Baking Co., Inc. and any other sponsors of this event to use all information submitted in this application, and any record of this walk containing my likeness, as well as walk results including my name, for any purpose whatsoever, including, but not limited to, pre-walk publicity. I hereby certify that I have read all the items and conditions of this release and intend to be legally bound thereby.

Yes, I have read and accept the terms of this waiver and release. No, I do NOT accept the terms of this waiver and release.