Walk Across Tennessee - HTN Tipton 2019
Individual Registration Form - this form must be submitted before beginning program
17 & under
18 to 25
26 to 35
36 to 45
46 to 55
56 to 65
If 17 and under, name of parent or guardian
My personal goals for participating are (check all that apply)
Controlling blood pressure
Improving blood sugar
Becoming physically active
Getting involved in my community
Team Captain’s name (first & last)
Shirt Size - First 90 registrants will receive a free t-shirt - SIZES NOT GUARANTEED
I wish to participate voluntarily in the Walk Across Tennessee physical activity for the purpose of personal fitness. I understand that I should have medical approval from my health care professional if I have any condition, chronic disease, or acute illness that would possibly inhibit or negatively affect my ability to participate in an exercise program. By typing my full name in the box below I agree to this waiver and agree to accept full responsibility for any injuries I may sustain while participating in this program and hold harmless all Sponsoring Parties.
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