Just Walk Registration

Just Walk Worcester - Key LiteYou can fill out the form below, or download a PDF version of the form here.

Participants under the age of 18 must have the application countersigned by a parent or guardian, or be otherwise legally empowered as minors to give effective, informed consent and to sign on their own behalf, and should download the PDF version of the form above.

  • Please complete the following questions about your physical activity over the previous three months.

    Select what best describes you next to each question. The following three questions are required fields to submit.

  • PC & Mac Users Please hold down your left mouse button as you sign your name. If you need to put your First and Last Name on two different lines, simply release the left mouse button and then click in the box again to sign your Last Name. You can also click on the refresh button in the lower left hand corner to "erase" your signature and start over.

    Mobile & Tablet Users You can use your finger or stylus to write your signature.

  • This field is for validation purposes and should be left unchanged.

Funding provided by Maryland Department of Health Center for Chronic Disease Prevention and Control

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