DARE TO B U- MAY 10, 2014

REGISTRATION FORM

DARE to B U (BRAVE, STRONG, PROUD) ' 2014

DARE to B U (BRAVE, STRONG, PROUD)

Live Free! No Shame!

Ride in a stroller, bring your furry friends, run, walk, but most importantly, let us gain knowledge about mental health, its effects and where to go. Help support those who currently fight, and honor loved ones lost after courageous battles against mental health. The B U Run was originally created in the memory of Mandi Diane LeBlanc to begin honest dialog about suicide, and the heartbreaking impacts of the stigma associated to mental health. We have since changed the event name to reflect the fact that it is not just a run it is so much more. DARE to B U (BRAVE, STRONG, PROUD) ' 2014 is designed to raise mental health awareness in children, youth and, adults. The focus for 2014 is to create hope and wellness while providing strategies to cope for people of all ages. Interactive sessions, informational booths and professionals, as well as an array of practiced speakers will be available throughout. Take home skills and knowledge in promoting physical, mental, and emotional health. This portion of the event is free, with no registration required! The Run/Walk will follow, (registration required) and proceeds will go to DARE to B U (BRAVE, STRONG, PROUD) ' 2015. *Please go to Facebook under DARE to B U (BRAVE, STRONG, PROUD) ' 2014 for more information, links to online registration and opportunities to volunteer OR pick up a registration at a Caisse Populaire in Clare. Inbox questions to Melissa Comeau or Karen Belliveau. Call us at (902) 769-3302. Please spread the word!

Today we shall strive to create a safe and respectful space, free of stigma, where you are free to simply B U We will then agree to take this invaluable understanding away with us in efforts to create an unconditional acceptance of all individuals for the greater good of family and community

Event Details
Date: May 10, 2014 Events: Speakers/Interactive sessions and to follow, choice of a 3K or 5K Run/Walk (Small snack included). Time: Registration walk/run: 8:30am; Speakers/Sessions: 9:30am; Run/Walk: 11am (rain or shine) Location: cole secondaire de Clare, 80 Placide Comeau Rd, Meteghan River, NS. Run/Walk: Registration will be free for preschoolers, 5$ for students, 10$ for university students, 15$ for adults and 25$ for families. Includes: Run/Walk Kits will be made available to you on the day of the event. (TShirt, Collapsible Water Bottle and Bib)

PLACE LOGO OR COMPANY

Run/Walk Registration and Waiver ___3K Run/Walk ___5K Run/Walk ___Donations to DARE to B U (BRAVE, STRONG, PROUD) ' 2014 Fund _____________ Amount Name/Family __________________________________________________________________ Address _________________________________________________________________________ City ________________________________________ P.O. Box ________________________ Phone _________________________ Email ______________________________ Number Adult Shirt Sizes: ___Small Number Youth Shirt Sizes: ___ Small ___Medium ___Medium ___Large ___Large ___XLarge ___XXLarge

* Complimentary run shirt, and a collapsible bottle will be available to the first 200 registrants. Number of Participants if Registered as Family:_______________________________________ PAYMENT METHODS: PRE-REGISTER - 1) Download registration forms from Facebook (under DARE to B U (BRAVE, STRONG, PROUD) ' 2014) or obtain one from a Caisse Populaire de Clare near you and return with payment to: 1349 Highway 1, Church Point N.S., B0W 1M0. Please make checks payable to: DARE to B U (BRAVE, STRONG, PROUD) ' 2014 Fund, account # 92429115. 2) Fill out a registration form at a Caisse Populaire de Clare near you and pay them directly, account # 92429115. 3) Credit Union Members may pay via e-transfer to abelliveau@hotmail.com or through transfer of payment directly to the account # 92429115. *Please ensure your name is located somewhere on the electronic transfer . YOU CAN ALSO REGISTER AND PAY ON THE DAY OF THE EVENT STARTING AT 8:30am. ALL RUNNERS and WALKERS PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT, WAIVER and RELEASE FROM LIABILITY WAIVER: I should not enter and run/walk unless I am medically able and properly trained. I agree to abide by any decision of a run official relative to any aspect of my participation in DARE to B U (BRAVE, STRONG, PROUD) ' 2014 on May 10, 2014 including the right of the official to deny or suspend my participation for any reason. I assume all risks associated with running in this event, including, but not limited to, falls, contacts with other participants, the effects of the weather, including high heat and/or humidity, conditions of the trails/roads, all such risks being known and appreciated by me. Having read this waiver and knowing thesefacts and in consideration of your accepting my entry, Ifor myself and anyone entitled to act in my behalf, waive and release the DARE to B U (BRAVE, STRONG, PROUD) ' 2014 Fund and all sponsors, their representatives, contributors of the run, any other persons assisting with the run, and their successors from all claims or liabilities of any kind arising out of my participation in the run even though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this for any legitimate purpose. I understand that the guest speakers and DARE to B U (BRAVE, STRONG, PROUD) ' 2014 will take place rain or shine as the speakers will be situated in the gym of cole secondaire de Clare. I certify that I am18 years of age or older, or that I am the Parent/Guardian of the entrant and am granting pe rmission for him/her to participate. Name (Please Print): Signature: Date:

* Registration is nonrefundable.