2025 Colorado Base Camp Trek Application

GENERAL INFORMATION

First Name

Last Name

Address

City

State

ZIP code

Email

Phone Number

Birth Month

Birth Day

Birth Year

Pronouns

What is your primary connection to Parkinson's disease (PD)?

How did you hear about this event?

FUNDRAISING COMMITMENT ACKNOWLEDGEMENT

By joining Team Fox for the Colorado: Base Camp Trek climb you will be provided with a guided summit in the Argentine Pass in exchange for raising a minimum of $7,500 due no later than September 12, 2025. One third of this commitment ($2,250) must be raised by May 30, 2025. All participants are responsible for purchasing their own flight, needed food, and misc. personal camping/hiking gear.

I pledge to raise $7,500.

GENERAL QUESTIONS

How do you plan on training for this trek?

Please share your fundraising plans with us. How do you intend to raise your fundraising commitment?

Let us know why you are interested in representing Team Fox.

CONFIRMATION OF TERMS

I understand I am responsible for all charges if I have not fulfilled my commitment amount by September 12, 2025. If I am not able to participate due to injury or other circumstances, I will still be required to fulfill the commitment amount by check(s) or credit card(s) by September 12, 2025. I understand I am responsible for providing my credit card information electronically upon creation of my Team Fox fundraising dashboard. I will be charged a $25 registration fee. I understand I am not on the team until officially notified by a member of the Team Fox staff.

I understand.

PARTICIPANT WAIVER

I am solely responsible for my own health and safety. I represent and warrant that I am physically able to participate in the Colorado: Base Camp Trek supported by The Michael J. Fox Foundation.

I agree, for myself, my heirs, executors, and administrators, to not sue and to release, indemnify, and hold harmless, The Michael J. Fox Foundation; its affiliates, officers, directors, volunteers, and employees; and all sponsoring businesses and organizations, their agents, and employees; from any and all liability, claims, demands, and causes of action whatsoever, arising out of my participation in this event and related activities, whether it results from the negligence of any of the above or from any other cause.

I authorize The Michael J. Fox Foundation to take and use photographs and/or videos of me during the event, for publicity, promotion, and/or for use in The Michael J. Fox Foundation’s future media related needs.

Full Name

Date:

MM/DD/YYYY

Animations

GENERAL INFORMATION

FUNDRAISING COMMITMENT ACKNOWLEDGEMENT

GENERAL QUESTIONS

CONFIRMATION OF TERMS

PARTICIPANT WAIVER