to a brochure of this event

jingle bells race form 2010:1
9/7/10
3:01 PM
Page 1
FIRST 1000 TO ENTER RECEIVE A
GIFT CERTIFICATE FROM
EMMAS BACKPORCH
AND THE WATERSTREET COOKER
FUNDRAISER FOR
ST. JOHN AMBULANCE
AND COMMUNITY LIVING
When and Where:
Saturday, December 11th, 2010 - 9:00 am.
Emmas Backporch - Old Lakeshore Road, Burlington
Race Start Time:
9:00 am Pearl & James Street, Burlington
Santa's are welcome to assemble their Suits and listen to
carollers while enjoying hot chocolate and apple cider in
Village Square (Santa's Village) before and after the
race. We will also provide baggage check there.
5k flat course throughout downtown, Burlington
Registration Fees:
$35.00 for the 5k until November 30th
$40.00 thereafter
$25.00 for the 5k with Santa Suit from last year
until November 30th $30.00 thereafter
Santa Suits:
* All race participants will recieve a Santa suit that must
be worn during the event. It will consists of a beard,
hat, jacket, pants and belt.
* The Santa suit comes in a size for men,
women and children.
* Please remember that all participants must wear the
full santa suit. Any runner not wearing the santa
suit will be taken off the course with no refund.
Awards for top 3 in each age category.
Please avoid parking near any church lots.
Race Kit Pickup:
Thursday December 9th: 11:00 am - 7:00 pm
Friday December 10th: 11:00 pm - 4:00 pm
Lions Club
471 Pearl St. @ James St., Burlington
Registration and race kit pick up on race day at
Lions Club 471 Pearl St. @ James St., Burlington
from 7:00 am until 8:30
Chip pick up is on race day only
Post Race Party:
At Emmas Backporch, the Waterstreet Cooker
& the Lions Club. The colour of your bib will
determine the location for your breakfast.
Cheques, Visa, Mastercard and AM/EX may be sent
to: VR Pro 561 Brant Street, PO Box 85030,
Burlington L7R 4K3
Or drop off to any Running Room location
Call 905-639-8053 or email: [email protected]
Community Living Burlington
Established in 1955, Community Living Burlington is Burlington’s
oldest and largest non-profit charitable organization. For over 50
years, we have dedicated ourselves to enriching the quality of life,
development and community integration of individuals with
developmental disabilities. This is achieved through residential
settings, adult day programs, integrated preschools, supported
employment, respite services and many more.
Upcoming Events
The Chilly Half Marathon and Frosty 5k
March 6th, 2011, Downtown Burlington
Register online at www.vrpro.ca or
www.runningroom.com or call 905-639-8053
or email [email protected]
JINGLE BELL REGISTRATION FORM
Name: ________________________________________
Phone #: ______________________________________
Address: ______________________________________
City: _________________________________________
Postal Code: _________________
Email: ________________________________________
Gender: _________ Age: ______
Birth Date (mm/dd/yyyy): ___________________
Physical ailments or medications:
_______________________________________________
_______________________________________________
Emergency phone numbers:
(home) __________________
(cell) ____________________
5 K Run $35 until Nov 30th
$40 thereafter
5 K Run with Santa Suit from last year $25 until Nov 30th
$30 thereafter
Total: $____________
Visa
MasterCard
AMEX
Cash
Cheque
Card Number: ___________________________________
Expiry Date: ______________
Signature: _____________________________________
Sorry no refunds!
Instructions / Rules:
1. Register on-line at www.vrpro.ca or www.runningroom.com
2. or, make cheques payable to “VR Pro” and mail to:
VR Pro, 561 Brant St. P.O. Box 85030,
Burlington, Ontario, L7R 4K3,
3. or drop off form at The Running Room:
3300 Fairview St Unit 6c. Burlington, Ontario
4. Make cheques for pledges payable to VR Pro
5. Email questions or comments to: [email protected]
Amateur Athletic Waver and Release of Liability:
I am participating at my own risk and waive all claims of every
nature against the organizers, officials, sponsors, and any other
participating agencies in respect to my personal loss, illness, bodily
injury or death resulting from participating in these activities. I also
fully understand the rigors of such a competition and I have prepared
myself physically for the walk or race. At the time of registration, I will
inform the organizers regarding any relevant medical condition. I
agree to follow the rules which govern road racing. I, the
undersigned, have read the above waiver and release, and
understand that I have given up substantial rights in signing it, and
sign it voluntarily.
_____________________________________________________
Signature
_____________________________________________________
Signature of Parent/Guardian
(if participant is under 18 years of age)
_____________________________________________________
Date: month/day/year
Address:
Participant Name:
Address:
Address:
Address:
Address:
Address:
Address:
Address:
Name:
Name:
Name:
Name:
Name:
Name:
Name:
Receiver’s initial:
Postal Code:
Postal Code:
Postal Code:
Postal Code:
Postal Code:
Postal Code:
Tel:
Tel:
Tel:
Tel:
Tel:
Tel:
Total:
Postal Code:
Tel:
Charity
being
supported
The person who collects the most pledges will receive a prize. Please designate pledges for Burlington Community Living (BCL)
or St. John Ambulance (SJA) You may also pledge on-line at www.vrpro.ca
Amount received: $
Postal Code:
Tel:
$
Pledged
9/7/10
FOR OFFICE USE ONLY:
Address:
Name:
(Please add another sheet if more space is required. Please print clearly so we can issue receipts as required).
Pledge Sheet
jingle bells race form 2010:1
3:02 PM
Page 2
www.emmasbackporch.ca
2010
Santa Jingle Bell 5k
Accommodation in partnership with the
Burlington Hotel Association
visit www.vrpro.ca.
9am Saturday, December11th, 2010
Burlington, Ontario, Canada
Canada’s only all-Santa race!