A Community Walk for All

c/o The Family Centre, 65 Hanson Ave., Kitchener, ON N2C 2H6 www.plnwwo.ca The Annual Amble “A COMMUNITY WALK FOR ALL”

Saturday, September 23, 2017 10 am - 1 pm The Family Centre, 65 Hanson Ave., Kitchener Registration Fee: Individual $10. Family (4): $25. *Free registration with minimum $25 in pledges. Please bring this form and your pledges to the registration table at the event. Check out the fun activities and agenda for the day on our website, www.plnwwo.ca or through email [email protected] *You can also donate by going to the Canada Helps DONATE NOW button on our website (indicate Amble). See you at the Amble!

Participant’s Names: ______

Addre ss (Full addre ss Amount Payment Amount Name Contact (Phone and Email) requir Pledged Method Collected ed for tax receip t)

Planned Lifetime Networks, Release and Indemnity:

I agree that at all times during the Planned Lifetime Networks (WWO) Amble/Community Walk my safety remains my sole responsibility. In consideration of the acceptance of my registration form as an entrant in the Amble/Community Walk, I , for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE and FOREVER DISCHARGE Planned Lifetime Networks (WWO), its staff, volunteers, the sponsors of this event, Family and Children’s services, The city of Kitchener OF and FROM ALL claims, demands, damages, costs, expenses, actions, causes of action, whether as a spectator, participant or otherwise, whether prior to, during or subsequent to the event. I FURTHER HEREBY UNDERTAKE TO HOLD AND SAVE HARMLESS and AGREE TO IDEMNIFY all of the aforesaid from and against 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 release, waiver and indemnity. I warrant that I am physically fit to participate in this event and grant permission for all photos that may be taken at the event to be used without compensation in any Planned Lifetime Networks (WWO) print or promotional materials such as but not limited to their website, annual report, and brochures. Signature(s): ______

Signature(s): ______

Date: ______Parent/Guardian Initials: ______Additional Sponsors

Paymen Addre Amount Amount Name Contact (Phone and Email) t ss Pledged Collected Method