REGISTRATION FORM

(BRAVE, STRONG, PROUD) DARE to B U (BRAVE, PUISSANT, FIER)

DARE to B U (BRAVE, STRONG, PROUD)

Live Free! No Shame!

Ride in a stroller, bring your furry friends, run,
walk, bike, 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 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 is designed to raise awareness in
children, youth and, adults. The focus 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 activities and initiatives
sponsored by DARE to B U.
*Please go to Facebook under DARE to B U 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 Karen Belliveau or call (02778-2750.

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 23, 2015
Events: Speakers/Interactive sessions and to
follow, choice of a 3K or 5K Run/Walk (Small
snack included).
Time: Registration walk/run: 8:30 AM
Speakers/Sessions: 9:30 AM
Run/Walk: 11:00 AM (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)

Run/Walk Registration and Waiver

I am registering for the: _____3K Run/Walk

_____5K Run/Walk

Donation to DARE to B U Fund: ________________

Name/Family __________________________________________________________________
Address _________________________________________________________________________
City ________________________________________ P.O. Box ________________________
Phone _________________________ Email ______________________________
Number Shirt Sizes: ___Small
Number Youth: ___ Small

___Medium

___Medium

___Large

___Large

___XLarge

___XXLarge

___XLarge

* Complimentary run shirt, and collapsible bottle will be available to the first 200 registrants.
Number of Participants if Registered as Family:_______________________________________
PAYMENT METHODS: 1) Download registration forms from Facebook (under DARE to B U or obtain one
from a Caisse Populaire de Clare and Meteghan Home Hardware and return with payment to: 1349 Highway
1, Church Point N.S., B0W 1M0. Please make checks payable to: DARE to B U 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.
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 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 these facts and in consideration of your accepting my entry, I for
myself and anyone entitled to act in my behalf, waive and release the DARE to B U Fund, CMHA-YDS and
all sponsors, their representatives, contributors of the event, any other persons assisting with the event, and
their successors from all claims, or liabilities of any kind arising out of my participation in the event 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 event for any legitimate purpose. I understand that the guest speakers and DARE to B U
will take place rain or shine as the speakers will be situated in the gym of cole secondaire de Clare.
I certify that I am 19 years of age or older, or that I am the Parent/Guardian of the entrant and am granting
permission for him/her to participate.
Name (Please Print):

Signature:

Date:

* Registration is nonrefundable.

(Canadian Mental Health Association - YDS Charity Number: 841562325)