Stand Up, Don`t Stand By! - Child Abuse Prevention Services

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Please make checks payable to CAPS
Join
Jo
in u
us
s ffor
or the
the first
first annual
a nual CAPS
an
CAPS Stand
Stand Up,
Up, Don't
D o n 't
Stand By 5K
5K Walk/Run
Walk/Run
n on Sunday,
Sunday, October
October 6,
6, 2013,
2013 ,
Stand
en M
eadow State
State Park
Park
at Sunk
Sunken
Meadow
Schools, families,
Schools,
families, businesses
businesses and
and local
local organizations
organizations will
w ill
have a unique
unique opportunity
opportunity to
to demonstrate
demonstrate and be
recognized
re
cognized for
for their
their commitment
commitment to child
child safety
safety and
and bully
b u lly
prevention.
pr
evention.
Child
Ch
ild Abuse
Abuse Prevention
Prevention Services
Se
ervices (CAPS)
(CAPS) is
is Long
Long Island's
Island's
leading
preventing
le
ading nonprofit
nonprofit dedicated
dedicated to
to pr
eventing bullying,
bullying, child
child
abuse and neglect
neglect among
among
g school-age
school-age children.
children. By w
working
o r k in g
together,
we
every
together, w
e ccan
an keep
keep e
very cchild
hild safe
safe from
from harm.
harm.
Proceeds
Pr
oceeds for
for tthe
he walk/run
walk/run will
will support
support the
the CAPS
Bully
Bul
ly Prevention
Prevention Center:
Center:
•
•
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In-classroom
workshops
grades
2-12
reach
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middle school children
children
face,
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how their
their parents
parents can
can help
help them
them
Professional
Professional development
develop
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training for
for educators
educators and
and
school
school professionals
professionals that
that help
help sharpen
sharpen their
their skills
skills
A Corporate
Corporate Sponsorship
Sponsorshi
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only benefits
benefits CAPS
CAPS
and
and tthe
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work we
we do
do every
ev
very day,
day, it
it also
also provides
provides your
your
organization
organization with
with a chance
cha
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to distinguish
distinguish itself
it s e lf
before,
before, during,
during, and
and after
after the
the event
event by:
by:
•
•
•
Exposing
Exposing your
your services
services to
to potential
potential clients
clients through
through
media,
media, campaign,
campaign, and
and print
print marketing
marketing
Associating
Associating your
your company
com
mpany with
with bully
bully prevention—a
prevention—a
hot topic
topic that
that is
is a concern
co
oncern on Long
Long Island,
Island, and
continues
continues to
to receive
receive local
local and national
national media
media
attention
attention
Giving
Giving back
back to
to the
the community
community in
in a positive
positive and
and
meaningful
meaningful way
w ay
Get
Up,
Don't
Get your
your employees
employees to
to Stand
Stand U
p, D
on't Stand
on
Stand By
against
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about
against bullying
bullying and
and th
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be excited
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department teams,
teams, or ask
ask your
your staff
staff to
to sign
sign up as
as
volunteers
volunteers to
to help
help with
with day-of
day-of responsibilities.
responsibilities.
Call
516-621-0552
Call 5
16-621-0552 x101
x10
01 for
for more
more information.
infformation.
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I am paying $ __________ for the selected
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I am pledging $__________ for the selected
sponsorship
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I am contributing $__________ as a straight
donation to CAPS
o
Check enclosed
o
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Make a secure donation online at
Stopbullyingcapswalkrun.karma411.com
Credit Card (circle one below, add account number &
expiration date)
Amex
MasterCard
VISA
Card#_________________________________________
Exp. _______________ Phone#____________________
Name: ________________________________________
Company ______________________________________
Billing Address:
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_______________________________________________
City/State/Zip: __________________________________
E-mail: ________________________________________
Please complete and mail to:
Child Abuse Prevention Services
P.O. Box 176, Roslyn, NY 11576
Or FAX: (516) 621-3767
PHONE: (516) 621-0552 x101
Visit us online at: www.capsli.org
CAPS is a 501(c)(3) non-profit registered with the State of New York. A copy
of CAPS' Financial Report is available through the New York State
Department of State. All donations support the educational programs and
services of CAPS and are tax-deductible to the extent allowed by law. CAPS
does not sell, share or lend its mailing lists to any organization or company.
SHORT OUTSIDE
Register
Registerby
bySept.
Sept.27,
27,2013
2013
REGISTER
REGISTERIN
INADVANCE
ADVANCETO
TORECEIVE
RECEIVE
AACAPS
CAPST-SHIRT
T-SHIRTAT
ATCHECK-IN
CHECK-IN
adult
adult__s
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REGISTER
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ONLINEAT
AT
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Or
Orplease
pleasecomplete
completeand
andmail
mailtoto
CAPS
CAPS
P.O.
P.O.Box
Box176
176
Roslyn,
Roslyn,NY
NY11576
11576
Or
Orfax:
fax:(516)
(516)621-3767
621-3767
Form
Pledge Form
Friends, Family and Co-Workers’ support of your efforts
on behalf of CAPS will directly support the Bully
Prevention Center. Please bring all donations to the
Walk/Run. Thank you in advance!
Donor Name
Email
Pledge $
Product/ServiceInforma
Informa
Product/Service
5K Walk/ Run
and Kiddie Fun-Run
SSc chhoo ol lTTe ea amms sCCoonnt at ac ct tCCAAPPSS
a at t551166- 6- 62211- 0- 055 522xx110011t ot oRRe eggi si tset er r
Sunday, October 6, 2013
______
______I Iam
ama awalker
walker
Sunken Meadow State Park
Kings Park, NY
______
______I Iam
ama arunner
runner
______
______Kiddie
KiddieFun-Run
Fun-Run(8(8and
andunder,
under,Strollers
StrollersWelcome*)
Welcome*)
9:00 a.m. Check-In
10:00 a.m. Start
______
______I Iwill
willvolunteer
volunteerday
dayofofthe
theevent
event
______
______I Iam
ama ateam
teamcaptain
captain
Walkers, Runners, Families
School & Corporate Teams
______
______##ofofteam
teamparticipants
participants
_______My
_______Myteam
teamname
nameis:is:________________________
________________________
All Ages and Skill levels
Are Welcome!
Name:
Name:________________________________________
________________________________________
Company:
Company:_____________________________________
_____________________________________
Address:
Address:_______________________________________
_______________________________________
Celebrate CAPS’ 30th Anniversary
Keeping Every Child Safe From Harm™
City/State/Zip:
City/State/Zip:__________________________________
__________________________________
Rain Or Shine!
Telephone#:
Telephone#:____________________________________
____________________________________
E-mail:
E-mail:________________________________________
________________________________________
*5K
*5Kcourse
coursenot
notconducive
conducivetotobaby
babystrollers.
strollers.
WAIVER
WAIVER(EACH
(EACHPARTICIPANT
PARTICIPANTMUST
MUSTREAD
READ& &SIGN
SIGNBELOW)
BELOW)
I, I,the
theundersigned,
undersigned,agree
agreetotoindemnify
indemnifyand
andhold
holdharmless
harmlessChild
ChildAbuse
Abuse
Prevention
PreventionServices
Services(CAPS)
(CAPS)from
fromallallcost,
cost,expense
expenseand
andliability
liabilityarising
arisingout
out
ofofmy
myorormy
mychild’s
child’sparticipation
participationininthis
thisevent
eventtotobenefit
benefitCAPS.
CAPS.I do
I do
hereby
herebywaive
waiveallallclaims
claimsforfordamage
damageororloss
losstotome
meorormy
mychild’s
child’sperson
personoror
property
propertywhich
whichmay
maybebecaused
causedbybyany
anyact
actororfailure
failuretotoact,
act,bybyCAPS,
CAPS,itsits
officers,
officers,agents
agentsororemployees
employeesarising
arisingdirectly
directlyororindirectly
indirectlyfrom
frommy
myorormy
my
child’s
child’sparticipation
participationininthis
thisevent,
event,and
andI hereby
I herebyassume
assumeliability
liabilityforforany
any
loss,
loss,damage
damageororother
otherliability
liabilityfrom
fromsuch
suchevent.
event.IMPORTANT!
IMPORTANT!I give
I give
permission
permissiontotoCAPS
CAPStotouse
useany
anypictures,
pictures,video
videofootage,
footage,etc…that
etc…thatis istaken
taken
atatthe
theevent
eventtotouse
useininfuture
futurepromotional
promotionalmaterials.
materials.
_______________________________________________________
_______________________________________________________
Participant’s
Participant’sSignature
SignatureororParent/Legal
Parent/LegalGuardian
Guardian
Date
Date
_______________________________________________________
_______________________________________________________
Participant’s
Participant’sSignature
SignatureororParent/Legal
Parent/LegalGuardian
Guardian
Date
Date
Total Pledge $
October is
Bully Prevention Month!