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28 - The Oakville Beaver, Wednesday June 13, 2007 www.oakvillebeaver.com Presented by Sunday, June 17th, 2007 Father's Day Rain or Shine for 20 8:45 a.m. - Kids Fun Run ew 9:00 a.m. - Run Ronald McDonald 9:10 a.m. Power Walk Fun 9:15 a.m. Walk 07 07 N OAKVILLE All proceeds will be used to purchase an Echocardiogram for the OTMH Cardiology Department Location: Wallace Park, between Reynolds and Allan, just south of the Hospital. Zone Entry Form One entry form should be completed for each participant or per family entrant. First Name* Address* City* Postal Code* Male Female Name Address Street/ City Postal Code Phone# Collected $ Cash Cheque Receipt Requested? Last Name* Province* Phone* Age* (Age required to be eligible for race prizes) (*) indicates required field John Doe (sample) 35 Grandview Street, Oakville L6J 4P9 905 555 555 300 Registration Fees For Run & Walk (no refunds) Note: All 5km and 3km participants receive an event T-shirt. Please check: 5km Run 5km Power Walk 3km Walk 1km Fun Run, children 12 & under $10 Adults and children age 15 and over: $25 $10 $50 After June 3rd After June 3rd After June 3rd $35 $15 $80 Children age 14 and under: Family of 4: (maximum 2 aged 15 & over) $10 extra (for each additional child) NAME 1 2 3 4 SEX AGE EVENT if 18 yrs or older y SIGNATURE Payment Options VISA MC CASH CHEQUE AMEX (Cheques payable to Oakville Hospital Foundation) Pledge Forms and all funds received must be handed in at the Pledge Desk on Sunday, June 17th, 2007. Card#: Name on Card: Expiry Date: Signature: Total pledges collected: $ Amount: Month Year 2007 CLASSIC WALK/RUN RELEASE & INDEMNITY In consideration of the acceptance and the permission to participate as an entrant or competitor in the 2007 Classic Walk/Run I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE Oakville Hospital Foundation, Oakville-Trafalgar Memorial Hospital, the organizers and sponsoring companies from any and all claims, demands, injury, loss or damages, costs, expenses, action, and causes of action whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in the said event, whether as a spectator, participant, competitor; whether prior to, during, or subsequent to the event AND NOTWITHSTANDING that the same may have been contributed to or occasioned by the negligence of any of the aforesaid. I HEREBY UNDERTAKE TO HOLD AND SAVE HARMLESS AND AGREE TO INDEMNIFY all of the aforesaid from and against any or all liability incurred by any or all of them arising as a result of or in any way connected with my participation in this event. BY SUBMITTING THIS ENTRY, I ACKNOWLEDGE HAVING READ, UNDERSTOOD, AND AGREED to the above WAIVER, RELEASE, and INDEMNITY, I WARRANT that I am physically fit to participate in this event. If this registration is a family registration and one or some of the participants is/are under the age of 18 years, I, being the responsible parent/guardian for such participant(s) under the age of 18 years, agree that the foregoing consent and release will apply on behalf of such participant(s) under the age of 18 years. I give full permission for the use of my name, photograph, electronic and video image by any of the parties (as defined above). NOTE: Oakville Hospital Foundation respects your privacy and we protect your personal information. We do not rent, sell or trade our mailing lists. The information you provide will be used to keep you informed of the Foundation's fundraising opportunities. If you would like to be removed from our contact list, please call us at 905-338-4642. Sponsors and Supporters. The Oakville Hospital Foundation invites you to join McDonalds and Oak-land Ford Lincoln in supporting this worthy cause by sponsoring or by participating in the run or walk and by pledging donations through your colleagues and friends. 2007 OTMH CLASSIC SPONSORS Co-Presenting Sponsors: Oakville Gold Sponsors: Silver Sponsors: Bronze Sponsors: Royal Lepage Real Estate Services Ltd., Brokerage , g Community Active Marketing Group · Cadbury's · Cogeco Cable · D'Orazio Infrastructure Group · Franklin Templeton Genex General Exhibition Corporation · Hawaiian Tropic Suncare · Hersheys · Mattamy Homes · Peter Karrys The Toronto Argonauts · Wow Powerwalking · Wyeth Breakfast Catered Fare · Longo's Maple Leaf Foods · Tasty Chip Pledge Brooks Whole Foods Markets FAX FORM: 905-257-6758 OR MAIL TO: OTMH CLASSIC, 327 REYNOLDS ST., OAKVILLE ON L6J 3L7 Single Entrant Signature: Family Entrant Signature: Parent/Guardian: (if under 18 yrs.)