Walk a Thon Forms
4
Walk/Run-a-thon for the Norwich Opti-Mist Splash Zone ~ All Participants will receive a glow in the dark Splash Zone bracelet and a ticket for a BBQ lunch consisting of a hot dog and drink~ Pledge Information $250 in pledges allows you to have a name (family, team) on the walkway into the Splash Zone. (See reverse for other sponsorship, naming opportunities) Saturday June 2. 2012 Harold Bishop Park Participation Options 5 km walk/run 10:00 am 2.5 km walk/run 10:15 am 1 km walk/run 10:30 am Grand Opening Ceremony 11:30 am Register as an individual or get a group together and create a team. This can be your family, sports team, a group of friends or neighbours. Exercising together is FUN! Students must return the registration form (on the back) to their classroom teacher in order to receive their pledge sheet to participate. For more information call Holley at 519-863-2123 or email: info@norwichoptimistevents Registration and pledge forms are available at Millard, Rouse and Rosebrugh and the Bank of Montreal. Our goal for this event is $10,000. PLEASE help your community and your new Splash Zone by participating in this FUN event.
description
Join us for our 2012 Splash Pad fundraising walk a thon
Transcript of Walk a Thon Forms
Walk/Run-a-thon
for the Norwich
Opti-Mist Splash Zone
~ All Participants will receive a glow in the dark Splash Zone bracelet and a ticket for a BBQ lunch
consisting of a hot dog and drink~
Pledge Information
$250 in pledges allows you to have
a name (family, team) on the
walkway into the Splash Zone. (See reverse for other sponsorship,
naming opportunities)
Saturday June 2. 2012
Harold Bishop Park
Participation Options
5 km walk/run 10:00 am
2.5 km walk/run 10:15 am
1 km walk/run 10:30 am
Grand Opening Ceremony 11:30 am
Register as an individual or get a group together and create a team. This can be your family, sports team, a group of friends or neighbours.
Exercising together is FUN!
Students must return the registration
form (on the back) to their classroom
teacher in order to receive their pledge
sheet to participate.
For more information call Holley at 519-863-2123 or email: info@norwichoptimistevents
Registration and pledge forms are available at Millard, Rouse
and Rosebrugh and the Bank of Montreal.
Our goal for this event is $10,000.
PLEASE help your community and
your new Splash Zone by
participating in this FUN event.
OPTIMIST CLUB OF NORWICH & DISTRICT
Opti-Mist Splash Zone
SPONSORSHIP LEVELS
GOLD SPONSORSHIP
$1,000
Personalized Stepping Stone
SILVER SPONSORSHIP
$500
Personalized Stepping Stone
BRONZE SPONSORSHIP
$250
Personalized Stepping Stone
Contribute by leaving a named memoir, which shows your support for
your friends or family, your community, your splash zone.
Optimist Club of Norwich and District, PO Box 1018, Norwich, ON, N0J 1P0 For more information email: [email protected]
Call: 519-863-2123
REGISTRATION FORM
Participants can bring their forms the day of the Run/Walk -A-Thon (ALL Students participating must return their permission forms to their teachers by
May 25, 2012 in order to receive their pledge sheet)
PARTICPANTS NAME: _____________________________________ GROUP NAME: ___________________________________________ ADDRESS: ___________________________________ PHONE: __________________ I __________________________ the parent/guardian for _________________________ give permission for her/him to participate in the Norwich Optimist Run/Walk-A-Thon on June 2, 2012. (Permission is needed for participants less than 18 years of age.)
Parent/guardian signature: _________________________________________________
Participation category: 5 km 2.5 km 1 km
DIAMOND SPONSORSHIP
$5,000
Custom Engraved Bench
PLATINUM SPONSORSHIP
$2,500
Custom Engraved Armour Stone
with Company Logo or Graphic
OPTI-MIST SPLASH ZONE Run/Walk-A-Thon Pledge Sheet
Date: Saturday June 2, 2012 in support of the NEW Splash Pad
Participant Name: ____________________________Phone: ________________Team Name (if applicable): _______________ Complete Address: ______________________________ City: ______________________ Postal Code: ___________________ *Make all cheques payable to Optimist Club of Norwich and District *Donations of $20 or more will receive receipts
Name Address Postal Code Phone $ Pledge Collected *Receipt
Thank you for your support! TOTAL: ______________
NAME: _______________________________________________ PHONE #: __________________________ NAME TO APPEAR ON SPONSORSHIP (Maximum 3 lines - 18 characters per line)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (_______________________________) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (_______________________________) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (_______________________________) SPONSORSHIP LEVEL
DIAMOND $5,000 PLATINUM $2,500 GOLD $1,000
SILVER $500 BRONZE $250
DONATION Amount $_____________
Please make all cheques payable to Optimist Club of Norwich and District.
THANK YOU FOR SUPPORTING THANK YOU FOR SUPPORTING THANK YOU FOR SUPPORTING THANK YOU FOR SUPPORTING YOUR COMMUNITY,YOUR COMMUNITY,YOUR COMMUNITY,YOUR COMMUNITY, YOUR SPLASH PAD!YOUR SPLASH PAD!YOUR SPLASH PAD!YOUR SPLASH PAD!
RELEASE AND WAIVER OF LIABILITY AGREEMENT I, ________________________ acknowledge that I have voluntarily applied to participate in the following activities at Splash Zone Run/Walk-A-Thon on June 2, 2012.
I AM VOLUNTARILY PARTICIPATING IN THIS ACTIVITY WITH KNOWLEDGE OF THE POTENTIAL DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. I verify this statement by placing my signature here: __________________ Parent or Guardian’s signature (if under 18): _____________________
