Volunteer

Registration

Your Name (required):

Address (required):

City (required):

Postal Code (required):

Phone Number (required):

Your Email (required):

Team Name (if applicable):

Yes, I wish to volunteer during the walk run on October 16, 2016.

Please place me in the following area:

Volunteer training and a full job description will be supplied prior to the event. After completing this form, you will be contacted with specific details. Return in person to NBRHC, 50 College Dr. Pod A2 or mail to NBRHC Foundation, Box 2500, North Bay P1B 5A4, by fax 495-8121 or email to vicky.sutherland@nbrhc.on.ca.

Our Hospital Walk/Run Waiver

I declare that I intend to participate in “Our Hospital Walk/Run” organized by North Bay Regional Health Centre Foundation. I understand that the North Bay Regional Health Centre is the beneficiary of the funds raised from this event.

I acknowledge that my participation in the Walk/Run is purely voluntary.

I understand that neither the North Bay Regional Health Centre Foundation nor North Bay Regional Health Centre take any responsibility for any harm, loss or damage to myself or my personal property arising or resulting from my participation in the Walk/Run.

I understand and acknowledge that there may be risks associated with my participation in the Walk/Run which are further outlined in the brochure provided, and which may include serious physical injury, permanent disability, and/or death. I further understand that these risks may be relative to my own level of skill, fitness, and/or health.

I understand that not all parts of the Walk/Run will be supervised and that it is my responsibility to inform myself of the risks involved in my participation and to monitor my progress in the Walk/Run and seek assistance and/or medical attention as necessary.

I assume full responsibility for consulting with a physician prior to and regarding my participation in the Walk Run. I understand that medical care and/or treatment are not being provided as part of the Walk/Run. In case of an emergency, I understand that 911 will be called.

I hereby release the North Bay Regional Health Centre and the North Bay Regional Health Centre Foundation the City of North Bay; the North Bay Police; the chief of Police; Canadore College; Nipissing University; Rogers Radio and their respective directors, officers, employees and agents; all sponsors; contributors and volunteers from all actions, causes of action, suits, claims, liability, damages and demands of any kind, whether direct, indirect, special, exemplary or consequential, including interest thereon (the "Claims") as a result of my participation in the Walk/Run.

I hereby agree to indemnify, hold harmless and forever discharge the North Bay Regional Health Centre and the North Bay Regional Health Centre Foundation the City of North Bay; the North Bay Police; the chief of Police; Canadore College; Nipissing University; Rogers Radio and their respective directors, officers, employees and agents all sponsors; contributors and volunteers from and against all Claims whatsoever incurred by the Hospital or such other persons if I suffer harm or loss, injure someone else or damage property as a result of my participation in the Walk/Run. I give my permission for and consent to the use of my name and picture on or in connection with any television or radio program, motion picture, print media or the advertising and publicizing of the Walk as may be designated by the North Bay Regional Health Centre (the “Promotions”) and waive all rights to remuneration or otherwise in connection with the Promotions.

Permission is required from a Parent or guardian for children under 18 years of age who wish to volunteer.
Parent or Guardian Name:

I have read the above waiver and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

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Coach Sponsors

Able's Locksmithing
Active Running & Therapy Centre
Algonquin Pharmasave
Boston Pizza
Fabrine AVINTIV
Farquhar's Orchards Fine Food
Independent Tire
Jim’s Locksmithing
Kennedy Insurance Brokers Inc.
K & T Port-A-John Ltd.
Lincluden Investment Management Limited
Next Step Life Fitness
Ricci’s Printing
The Black Birds
The Fun in Fitness Club
The New Skin Image
TransCanada Pipelines Limited
Twiggs Coffee Roasters

Fan Sponsors

Bernard Rochefort Limited