KCCHSD Breast Cancer Awareness Walk

Thanks to all who came out for this one... It was a HUGE success!!
Burlington Community Center - 340 South 14th Street

We can't wait until this time NEXT YEAR!!
A BIG Thanks goes out to all of our sponsors!

Click here if you would like to be a sponsor in this year's Breast Cancer Awareness Walk

Click here if you would like to view our flyer!

Click here to view the 2018 Breast Cancer Awareness Walk Guide!!

Please note: Each participant must have a completed Release form completed. If you are paying for multiple people, please print this form and have each participant fully completed it. If a participant is under the age of 18, a Legal Authority of Parent or Legal Representative must sign the paper version for the Release form. Forms must be collected before the walk. Forms can be mailed or dropped off to Hillary Dwyer or Admissions at Kit Carson County Memorial Hospital, 286 16th Street Burlington, CO 80807.
If you are over the age of 18 and sign the form below electronically, you do not need to sign a paper form.

Breast Cancer Awareness Walk

Amount: *

Credit Card Number: *

Expiration Date:

Card Security Code (CSC) *

First Name: *

Last Name: *

Address: *

Address Continued:

City: *

State: *

Zip: *

Country: *

Email: *

Phone Number:

Submission Date *

T-Shirt for person completing the form: Child/Adult *

T-Shirt Size: (Children's only come in Small-Large) Small
Medium
Large
XL
2XL
3XL

If you are paying for more than one person please list their names below followed by their shirt size. They will receive an adult t-shirt unless otherwise noted.

Team's Name (optional):

If you were referred by a KCCHSD employee, please list their name:

By electronically signing this box, I acknowledge that I have read and understood the following release and waiver and agree to its terms

KCCHSD Breast Cancer Awareness Walk

Thanks to all who came out for this one... It was a HUGE success!! Burlington Community Center - 340 South 14th Street

We can't wait until this time NEXT YEAR!! A BIG Thanks goes out to all of our sponsors!

Breast Cancer Awareness Walk

Thanks to all who came out for this one... It was a HUGE success!!
Burlington Community Center - 340 South 14th Street

We can't wait until this time NEXT YEAR!!
A BIG Thanks goes out to all of our sponsors!