On the Move for Special Needs
Thank you for participating in this fun event! All paid registrations will receive a t-shirt. All paid registered pets will receive a pet bandana. Adults ages 19 on up ~ $50 Youth 12-18 ~ $25 Ages 0-11 ~ FREE (does not include t-shirt. If you would like a shirt for your child in this age group, please register them as a youth) Pets ~ $15 IMPORTANT NOTICE: Unfortunately, our payment site is down for the moment. Please call Cyndee at 925-768-7137 to complete your payment.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your t-shirt Size (adults sizes only)
*
Please Select
S
M
L
XL
2XL
3XL
Name of persons in your group. Please include first and last
*
Number of t-shirts needed for your party. T-shirt number must match the number of paid registrations listed below.
Number of small t-shirts needed for your group
Number of medium t-shirts needed for your group
Number of large t-shirts needed for your group
Number of XL t-shirts needed for your group
Number of 2XL t-shirts needed for your group
Number of 3XL t-shirts needed for your group
How would you like to receive your t-shirt?
*
Please Select
I am participating virtually. Please mail my shirt.
I will join you in Kingsburg. Please mail my shirt.
I will join you in Kingsburg. In order to save on shipping, I will pick up my shirt at the event.
Payments and Donations
*
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Adult ages 19 on up
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Youth ages 12-18
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Youth 0-11
Free
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Pets
$15.00
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Register
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