Braveheart Walk for CHD Awareness

Saturday, June 7th, 2014

Registration opens at 10:00 am, Walk starts at 11AM

DalhousieUniversity, Studley Gym, Halifax

Gym entrance is on University Ave opposite the Killam Library

withsupport from

First Name:______Last Name:______

My Team Name is (if participating on a team): ______

Dear Potential Sponsor:

I am participating in theBraveheart Walk for CHD Awareness. The Braveheart Support Society seeks to support individuals and their families affected by congenital heart disease through services such as monthly parent meetings, ongoing peer to peer support and other family events throughout the year. They also endeavor to raise public awareness though information booths, information sessions, CHD brochures and CHD presentations.

Proceeds raised from this walkathon will fund their education and support programs. You can sponsor me for any amount and cheques can be made payable to “IWK Foundation” – note Braveheart Support Society in memo line. Donations of more than $20 will automatically receive a tax receipt. Thank you!

**Donors are responsible for completing all contact information, if they require a tax receipt. All information must legible.

Name / Phone Number / Donation Amt / Payment Method / Receipt?
Cash Cheque / Y N
Mailing Address / Postal Code / Province
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Cash Cheque / Y N
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Cash Cheque / Y N
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Cash Cheque / Y N
Mailing Address / Postal Code / Province
Name / Phone Number / Donation Amt / Payment Method / Receipt?
Cash Cheque / Y N
Mailing Address / Postal Code / Province
Name / Phone Number / Donation Amt / Payment Method / Receipt?
Cash Cheque / Y N
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Cash Cheque / Y N
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Cash Cheque / Y N
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Name / Phone Number / Donation Amt / Payment Method / Receipt?
Cash Cheque / Y N
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Total Cash: $ Total Cheques: $ Total On line donations: $
Grand Total: $______

Additional Information:

  • If weather permits, the walk will take place outside on location at Dalhousie University. If weather is inclement, will take place inside Studley Gym, Dalhousie University
  • Please bring this form (attach to registration form) and all funds raised with you on the day of the Braveheart Walk for CHD Awareness, Saturday, June 7th, 2014 at Studley Gym on the Dalhousie University Campus, Halifax at 10:00am, walk begins at 11 am.
  • Heart healthy snacks/refreshments will be provided.

Prizes will be awarded to the participant & team raising the 1st, 2nd & 3rd highest amounts of funds.

Note: Participant must participate in the walkathon in order to win a prize.

If you have any questions, please visit our website at You can also contact Yarrow Gillis, by email at or phone (902)478-8574.