Duck Adoption Sign Up
Form
Mini rubber ducks will be dropped in the pool
at Champion Credit
Union Aquatic Center around 5:30 PM on Saturday, July 19,
2025. The first duck that goes to the end of the pool will win
a grand prize. The grand prize will be $2,000 if
5,000 ducks are adopted or we get a presenting sponsor. *Check
out our video.
Other prizes are:
a $1,000 Walmart gift card for 2nd
place duck and a $500 Walmart gift card for
3rd place duck. We will have smaller
prizes for 4th, 5th, and 6th place ducks.
All ducks are numbered and assigned to people
who have adopted them. This will help to determine the winners.
You do not have to be present at this
event to win prizes. We will
contact you via email if you win anything.
This form is only for those who are paying for
adoption of ducks by credit card. The cost of adopting ducks
for the race is a little higher if you pay by credit card due
to the processing fees. If you wish to pay by check, please
download this Duck
Adoption form and mail it to Medical Patient
Modesty, P.O. Box 652, Hazelwood, NC 28738 along with
a check payable to Medical Patient Modesty.
*After you fill out this form,
you will be taken to a web page that asks you to click on a
button to pay. Be sure to click on that button. Another form
will open. Be sure to fill out that form to pay by credit card.
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