Walk and Roll 2015 brochure, pledge sheet and registration

Walk & Roll Corporate Sponsors
Baden Coffee Company
Barber Collins Security Services Ltd.
Brody Enterprises Inc.
Complete Hearing Health
Diversey Care
Giesbrecht, Griffin, Funk & Irvine LLP
JIKS Industrial Kitchen Services Ltd.
KR Communications Ltd.
KW Insurance Brokers
K-W Community Spirit Lions
Lions Club of Kitchener
Medical Mart
Medical Pharmacies Group
ProResp
Qwatro-Royalpak
Royal Canadian Legion Branch 530 Waterloo
Scotiabank
Shoppers Home Health Care
Sorbara Law
SYSCO
Design and printing courtesy of
Corporate Publishing (Region of Waterloo).
3.5k Walk & 1.5k Wheelchair Roll
Saturday, June 13, 2015
A fundraiser in
support of Sunnyside
247 Franklin Street North, Kitchener
Tel: 519-893-8482 • Fax: 519-893-4450
www.sunnysidefoundation.ca
Registered Charitable
# 87728 8167 RR0001
COMMUNITY SERVICES
LOTS TO DO AND SEE
Foundation
Annual Walk & Roll
Proceeds from Walk & Roll will be used to fund ceiling lifts to
Saturday
transfer residents with ease and dignity and purchase towel
blanket warming units.
June 12,and2010
Walk & Roll has raised $650,000 over the years. This fun
filled, family fundraiser contributes to the comfort, safety and
quality of life for the people who live at Sunnyside Home and
Supportive Housing and who participate in the Community
Alzheimer Program and use the Sunnyside Wellness Centre.
SCHEDULE OF EVENTS
10 a.m.
Registration, pledge drop off and t-shirt pick up in
Kenneth parking lot, Sunnyside.
10:50 a.m.Aerobic warm up.
11 a.m.
3.5 km walk along Franklin, Shuh, Idlewood,
Glenwood Streets and 1.5 km wheelchair roll around
the Sunnyside campus.
12 noon
Lunch for registrants.
12:30 p.m. Prizes for top pledge collectors and door prize winners
followed by a silent auction.
– Additional parking available at St. Luke’s Lutheran Church on Franklin
•
enjoy the beautiful sounds of the Royal City Big Band
•experience a therapeutic massage provided by students from the
College of Massage and Hydrotherapy
• see antique cars and talk to the owners
• have your face painted
• join the drumming circle with the Sunnyside music therapists
• try your luck at the children’s games and win a prize every time
PRIZES
Family with the Highest Pledges
Set of cedar Adirondack chairs donated by Robert Brohman
Enterprises Inc.
Team with the Highest Pledges
Dinner for four courtesy of Edelweiss Tavern, Kitchener and
admission tickets donated by Canada’s Wonderland.
Individual with the Highest Pledges
Amazon Kindle Fire HD tablet donated by Tom Bevenborn, KW
Insurance Brokers and Sunnyside Foundation board member.
Resident/Tenant with the Highest Pledges
Therapeutic massage with Vassily Salytchev, RMT, Sunnyside
Wellness Centre and shampoo and cut courtesy of Reflections Beauty
and Barber Shop, Sunnyside.
Door prize draws for registrants and volunteers donated by local
businesses and friends of Sunnyside.
SILENT AUCTION
• Each item will have an opening minimum bid
• Cash, cheque, MasterCard and Visa will be accepted
PLEDGE SHEET
Sunnyside Foundation
Annual Walk & Roll
1. 2. 3. 4. PLEASE PRINT CLEARLY.
NAMES, ADDRESSES & POSTAL CODES are required for issuing receipts for donations of $10 and over.
Receipts will be issued at year end.
Photocopy additional copies as required.
All registrations ll,
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June 13, 2015
Participant’s Last Name: _____________________________________________ First Name:_________________________________________________
Address:__________________________________________________ City/Town: _______________________________ Postal Code: _____________
Team/Family Captain’s Name:____________________________________________________________________________________________________
PLEASE PRINT
NAME ADDRESS CITY
POSTAL CODE PLEDGE AMOUNT
Total Brought Forward
Please make cheques payable to Sunnyside Foundation
Registered Charitable # 87728 8167 RR0001
AMOUNT
PAID
NAME ADDRESS CITY
• Visa and MasterCard accepted, please include card number and expiry date
• Pledges can be made online at www.sunnysidefoundation.ca/makeadonation
POSTAL CODE PLEDGE AMOUNT
AMOUNT
PAID
Total Brought Forward
Partial Payment
Full Payment
Total pledge submission of $__________,
_Signed: (participant) ____________________________________ Date _____________________
Please accept my partial submission of $__________, and I will forward the balance of $ __________
by (date)_______________.
_Signed: (participant) ________________________________________ Date _________________
Please make cheques payable to Sunnyside Foundation
Registered Charitable # 87728 8167 RR0001
FRE
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REGISTRATION
Last Name (Team Captain) First Name
Street Address/Apt. number City
Prov. Home Phone
Postal Code
Business Phone
Email Address
Individual Registration Fee: $25
❏ Registration fee waived for minimum of $100 in pledges and your name will be entered to win door prizes.
Team Registration Fee: $100
❏ Registration fee waived for minimum of $300 in pledges ($ amounts are per team) and your names
will be entered to win door prizes. Group of four (4) individuals.
Family Registration Fee: $100
❏ Registration fee waived for minimum of $200 in pledges and your names will be entered to win door
prizes. Group of four (4) individuals.
Team captain name: T-shirt size
Team member name: T-shirt size
Team member name: T-shirt size
Team member name: T-shirt size
T-shirt sizes: Youths S(2-4), M(6-8), L(10-12), Adults S, M, L, XL
Waiver
In consideration of the acceptance of my application and the permission to participate as an entrant or competitor in the 2015 Sunnyside Foundation Walk & Roll, I, for myself,
my heirs, executors, administrators, successors, and assigns hereby release, waive, and forever discharge the corporation of the City Of Kitchener, the Regional Municipality Of
Waterloo, the Waterloo Regional Police Force, the Region Of Waterloo Auxiliary Police Services Board, the Chief Of Police, Sunnyside Seniors’ Services, Ministry of Health and
Long Term Care and Waterloo Wellington Local Health Integration Network, and all other associations, sanctioning bodies and sponsoring companies, and all their respective
agents, officials, servants, contractors, representatives, successors and assigns of and from all actions, causes of action, suits, claims and demands whatsoever which I may
have by reason of or in any way arising or to arise by reason of my participation in the said event, whether as a spectator, participant, competitor or otherwise; whether prior
to, during or subsequent to the event and notwithstanding that same may have been contributed to or occasioned by the negligence of any of the aforesaid. I further hereby
undertake to hold and save harmless and agree to indemnify all of the aforesaid from and against any or all liability incurred by any or all of them arising as a result of, or in any
way connected with my participation with the said event. By submitting this entry, I acknowledge having read, understood, and agreed to the above waiver release and indemnity.
I warrant that I am physically fit to participate in this event, and have attained the age of 19 years, or if not 19 years of age, my parent or guardian has signed on my behalf. I
also authorize the use of any photographs of me (or my child) taken at the event for the promotion of the Sunnyside Walk & Roll.
(Signed) x . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Date). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Team signatures). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Team signatures). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NO IN-LINE SKATES OR BICYCLES