Registration Form
Individual
Family (check 1)
________________________________________________
Primary Registrant’s Name
_________________________________________________
Address
_________________________________________________
City/ State/ Zip
_________________________________________________
Daytime Phone
_________________________________________________
e-mail address
Additional Family Members:
In 2016:
o 114 Babies were reported to the
Center Births!
o 52 babies were saved when “Mom”
saw them on the ultrasound screen
o 4 woman considered adoption and we
have confirmed that 1 completed the
process in 2016.
o 106 clients made a salvation decision.
Communit Pregnancy Center
4230 Vista Road, Pasadena, TX 77504
Phone: 713-944-1730
www.cpcsupporter.com
www.cpcpasadena.org
________________________________________________
Name
Age
San Jacinto Battleground
Waiver and Release
_________________________________________________
Name
Age
_________________________________________________
Name
Age
_________________________________________________
Name
Age
Images of CPC Pasadena events captured through video, photos,
or digital camera become the property of CPC Pasadena.
I have read and fully understand the important information, risk,
assumption of risk, and waiver and release of all claims included
on the next page
Signature of registrants over 18:
______________________________________________________
__ _______________________________________________________
Read this form carefully and be aware that in signing and
participating in this program/activity, you will be expressly
assuming the risk and legal liability and waiving and releasing all
claims for injuries, damages or loss which you or your minor
child/ward might sustain as a result of participating in any and all
activities connected with and associated with this
program/activity.
I recognize and acknowledge that there are certain risks of physical
injury to participants in this program/activity, and I voluntarily
agree to assume the full risk of any and all injuries, damages, or
loss, regardless of severity, that I or my minor child may have (or
accrue to me or my child) as a result of participating in this
program/activity against Community Pregnancy Center of
Pasadena, including its officials, agents, volunteers and employees.
I do hereby fully release and forever discharge the Community
Pregnancy Center of Pasadena from any and all claims for injury,
damages, or loss that my minor child or I may have or which may
accrue to me or my minor child and arising out of, connected with,
or in any way associated with this program/activity. I have read
and fully \understand the above important information warning or
risk, assumption of risk and waiver and release of all claims. If
registering by email, your email signature shall substitute for and
have the same legal effect as an original form signature.
3523 Battleground Rd,
LaPorte, TX 77571
Enter at Gate 3 (exit 225 at Independence
Parkway, proceed to the “Y” in the road,
which will lead to Gate 3).
Registration begins at 9am
Walk for Life Sponsor Sheet
Sponsor Name
Address
Phone
Amt. Pledged
Cash
Check
Online
PD.
Add to
Mailing
List
Community Pregnancy Center is a 501(c)3 corporation , and all donations are tax deductible per the IRS tax code. You can donate online at
www.cpcsupporter.com. Click on the link, and at the line “I would like this donation used for” type your walker’s name, and your favorite walker will
receive credit in their totals.
Thank you for helping me help women, teen girls, and babies receive the assistance they need! CPC will provide receipts for gifts
over $25.00 when all information above is complete and legible.