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Sponsor Donation Form:
This is our community challenge:
Thanks for running/walking! You’re encouraged to invite family,
friends and co-workers to sponsor you. Don’t forget that some employers have matching gift programs to double the value of a pledge.
It’s easy. Ask your employer for a form.
Some important information about pledges:

Bring this completed form with you to the RUN/WALK to document
the total donated.
 For every $100 in donations raised you will earn one entry into our
prize drawing!!
 Collect donations on your personal page:
http://kennethyoung.donorpages.com/Walk2015
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Sponsor’s Name & Address
Attached
Donation Online
with
Amount payment form
My Donation
$
x
x
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 Run or walk with us to help those who are struggling and need
help getting back on track. It could be your neighbor, friend or family member. It may even be you.
Every dollar we raise will help change the community...
 $75 buys a month’s medication for a depressed client with limited
income.
 $100 provides shopping assistance for one month for a
homebound senior.
 $250 covers the cost of three therapy sessions for a family in
crisis.
We can reach our goal...
 Set a personal goal of at least $100.
 Every dollar counts and every dollar will help change your
community!
 I will run and bring my donation form and money to the event.
 I will walk and bring my donation form and money to the event.
 I’m unable to run/walk but here’s my donation of $
Make checks payable to Kenneth Young Center
4
Credit Card #
5
6
Visa
MC____Amex
Exp date
or donate online at www.kennethyoung.org.
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8
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Total:
Please make checks payable to Kenneth Young Center. Kenneth Young Center, 1001 Rohlwing
Rd, Elk Grove Village, IL 60007 *** Donations can also be made online: www.kennethyoung.org
Name
Name (please print):
Address
City
Waiver: I assume all risks associated with running/walking in this event, including but not limited to: falls, contact with other participants, effects of weather and conditions of the road, all
such risks being known and appreciated by me. Having read this waiver and knowing these
facts I hereby for myself, heirs, executors and administrators waive any and all claims I may
have for damages against Kenneth Young Center and all sponsors and individuals associated
with this event, their representatives and successors, and assignees for any and all injuries
suffered by me in connection with this event, including pre and post event activities. I hereby
grant permission to Kenneth Young Center and its authorized agents to use my name and photographs, recording or any other record of my participation in this event for any purpose. There
will be a $20 fee for all returned checks.
State
Zip_
Daytime phone#
E-mail
I am representing this organization (if applicable):
Signature:
Date:
If under 18
parent signature:
Date:
Kenneth Young Center
Here’s just about everything you need to know:
Where:
Busse Woods, Level IV area, south side of Higgins Road, just
west of Arlington Heights Rd.
When:
Saturday, May 9, 2015
What:
3.1 mile run/walk. Family/pet-friendly event. Please remember
dogs must be on a leash and no bikes. Strollers are welcome.
Why:
-
How:
-
for mental health and senior services
8:00 am check-in; 9:00 am start
Raise money to support Kenneth Young Center’s programs
and services.
Increase awareness of mental health related issues.
Help frail seniors struggling to maintain independence.
Help children, families and adults in crisis and/or struggling
with difficult situations.
Enjoy wonderful giveaways, prizes, food, music and a special
appearance by Iron Hero.
Sign up using the form in this brochure or by going to:
http://kennethyoung.donorpages.com/Walk2015
Registration: Cost for official chip timing: $25 for runners
$10 for runners (under age 18) and $40 for families
Suggested donation for walkers: $25/ per person, $40 per families
- Collect money or sponsors may donate online at
http://kennethyoung.donorpages.com/Walk2015.
- Begin collecting sponsor donations early!
- Generate more excitement and funds by forming a team with
your family, co-workers, friends, etc.
- Bring sponsorship and registration forms along with donations on
the day of the RUN/WALK.
Pre-register, set your goal and notify your friends!!
For every $100 in donations raised you will earn one entry into our prize
drawing! We will also have a raffle with tickets available for purchase the
morning of the walk.
Your footprints mark a brighter path.
$10
Buys a book to help family members understand mental illness
$25 Pays for one hour of group education to help seriously mentally ill
children remain in the community
$50
Pays for a client in desperation to attend a group therapy session
$100 - Pays for one psychiatric follow up session for a child on
medication
$200 Pays for 40 seniors to receive nutritious home delivered meals
Saturday, May 9, 2015
Questions: Call 847-524-8800 x141 or [email protected] or visit
www.kennethyoung.org.
8:00 am check-in
Premier Sponsor: Pepsi Beverages Company
Busse Woods
Level IV Area
Sponsors:
Alexian Health Systems, Elk Grove Village Bank & Trust, American Foundation for
Suicide Prevention and Dick Pond
www.kennethyoung.org