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
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
How many bandanas do you need? Must match the number of paid registrations.
Register
Should be Empty: