Document 6556223

Organization Name: Team Name: Event Date: Event Location: á
Required fields
á
Name: á
Address: á
City:
á
á
Province:
Telephone:
Gender:
á
M
F
Postal Code: Email: Have you ever participated in the Heart&Stroke Big Bike ride before?
14 – 20
Age Category:
21 – 30
31 – 40
41 – 50
51 – 60
YES
NO
61+
I would prefer to donate my prizes back so that more dollars can go towards Heart and Stroke Foundation Research:
á
I have read, signed and agreed to the terms of the waiver form on reverse:
Remember – all Big Bike participants must fundraise $50 or more. Find out more at bigbike.ca
Tax receipts will be issued for pledges of $15 or more or upon request. We cannot guarantee a tax receipt if information is not clear and complete. Please include
full address for tax receipting purposes. All online donations will receive an automatic tax receipt. Please make cheques payable to: Heart and Stroke Foundation.
Sponsor’s Name (First and Last)
Mailing Address
Mary Smith
123 Anywhere Street
Ple
rec
o
rd
c
ash
Postal Code
My town
and
che
que
don
atio
B1B 2A2
ns
onl
yo
Phone No.
Pledge
(111) 123-4567
$20.00
n th
is f
orm
Company to match me
Need more space? Print another pledge form at bigbike.ca
TOTAL
COLLECTED:
Presented by:
$
CASH AND CHEQUES ENCLOSED
$
AMOUNT RAISED ONLINE
$
TOTAL RAISED
$
+
RIDE BIG. LIVE BIG.
Receipt
Issued
✓
Shaded area for office use only
ase
City
=
REGISTER AT bigbike.ca
FOR A CHANCE TO WIN YOUR DREAM VACATION!
BIG BIKE PARTICIPANT RELEASE OF LIABILITY AND INDEMNITY WAIVER
The Heart and Stroke Foundation (HSF) REQUIRES ALL PARTICIPANTS TO AGREE TO
AND ABIDE BY THE TERMS AND CONDITIONS set forth in this Release. The HSF organizers
and sponsors reserve the right at any time to disallow any participant from continuing to
participate in this event if it is deemed necessary for whatever reason. By signing on the line
below it indicates that the Participant acknowledges and freely accepts the terms and
conditions set forth herein. Participants must be 14 years old or older.
I,
intending to be legally bound, understand and agree that
I am voluntarily participating at my own request and at my own risk. I acknowledge that I am
aware and understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively
called RISKS) associated with any physical activity. I Freely Accept and Fully Assume All
Responsibility for the Inherent “RISKS” and the possibility of personal injury, death,
property damage or loss which might result from my participation in this Big Bike program.
I certify that I am physically fit, have not been otherwise informed by any physician and know
of no restrictions imposed on me by my own physician that would in any way prevent me
from actively participating in this program.
YOUR BIG RIDE CAN HELP SAVE LIVES!
Heart disease and stroke remain a leading cause
of death in Canada, but with the help of dedicated
teams like yours, we can raise vital funds that help
give us all more time!
3 STEPS TO SUCCESS
1. REGISTER FOR YOUR EVENT TODAY AT BIGBIKE.CA.
Online fundraising is easy and you could win your dream
vacation, worth $7,500. Simply visit BigBike.ca, click Register
Now, sign up and participate to be automatically entered.*
•• Captains – click on Start a Team and
search by the city you are riding in.
If the Big Bike is considered to be a bike in my province, I agree to comply with the helmet
laws and to ensure that the helmet will be mechanically fit for its intended purpose, properly
fitted and within approved Canadian government standards.
In consideration of being permitted to participate in this Big Bike program, I, on behalf of
myself, my successors in interest, heirs, assigns and representatives, hereby fully release and
agree to hold harmless the Heart and Stroke Foundation, their affiliates, their Officers,
Trustees, agents, employees, and representatives, successors and entities, of and from any
and all liability, claims, damages or causes of action for any reason, even as a result of
negligence by any of these parties or of any one acting on their behalf, including without
limiting the generality of the following: death, bodily injury, property damage, or any other
loss, or inconvenience whatsoever, suffered by me at any time hereafter occurring as a result
of my voluntary participation in this program.
I acknowledge that I have read this RELEASE, FULLY UNDERSTAND ITS TERMS AND
CONDITIONS, UNDERSTAND THAT I am giving up substantial rights by accepting the
terms of this agreement, accepting it freely and without any influence or inducement.
I also consent to the use of my name, likeness and/or voice, photograph, and that of
any minor under my care, without compensation in any future publicity carried out by the
Heart and Stroke Foundation.
•• Riders – click on Join a Team and
search by Team Captain, Team Name
or city you are riding in to register.
*Subject to rules and regulations, at bigbike.ca
2. FUNDRAISE TO EARN A BIG BIKE T-SHIRT!
Remember, all Big Bike participants must fundraise
$50 or more to Ride. Raise more than $100 to earn
a Big Bike t-shirt!
RAISE
More than
$100
BIG BIKE T-SHIRT
You can donate
your prizes back
to maximize
your fundraising
impact to the
Foundation.
Must be signed by parent or legal guardian if participant is under
the age of 18 on the date this release is signed.
3. GO BIGGER! BECOME A VIP!
Raise at least $500 to become a Very Important Philanthropist
(VIP) and earn a BIG place in our hearts!
Team Name:
Participant Name:
Participant Signature:
Print Name
Parent/Guardian Name:
Participant age (if a minor):
Print Name
Date:
(Month/Day/Year)
I certify below that I am the parent or legal guardian of the participant, and as such on
behalf of myself and the participant, agree to the terms of this Release, and release all
parties set forth above from all liabilities, and indemnify and hold harmless these parties
from all liabilities.
Parent/Guardian Signature:
We are committed to protecting the privacy of your personal information. We may maintain a record of your interaction for donor-related,
promotion and tax receipting purposes, where required. Occasionally, we may contact you with mission-related communications. If you wish
no further contact or have any questions or concerns regarding the privacy of your personal information, please contact The Chief Privacy
Officer, at your provincial HSF office at 1-888-HSF-INFO (1-888-473-4636) or www.heartandstroke.ca/privacy.
TOGETHER, OUR BIG HEARTS MAKE A BIG DIFFERENCE.
The Heart and Stroke Foundation is a member of Imagine Canada. When you raise funds on our behalf, it is your responsibility
to follow Imagine Canada’s ethical and environmentally responsible guidelines as outlined at heartandstroke.ca