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