Register for the Coquitlam Crunch “Diversity” Challenge

Registration Form:

Print Name (required):

(First and last name as you would use for tax purposes)

Children Name:

(Names of children name if they are participating in Challenge. Print names separated by a comma "," )

Other Family Member Name:

(Other family member names participating in Challenge. Print names separated by a comma "," )

Email (required):

Phone:

Category: Make-it or Break-ItRecreationalEvent Volunteer

Donation (optional):

You may choose to donate online by going to the CoquitlamFoundation.com, click on the ‘Donate Now’ button and select Coquitlam Diversity Fund from the drop down menu or directly donate through Canada Helps.

Donate Now Through CanadaHelps.org!