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Toolkit Dear Participant, We are so HAPPY that you have decided to take part in this FUN and EXCITING Fundraiser and Competition, “The Heavy Hitters Ultimate Challenge.” The goal is to get the adult in your team in the ring. As a team, you will be competing against other teams in the following activities: Jump Rope Challenge Heavy Bag Challenge Speedbag Challenge Circuit Training Challenge Ultimate Challenge At the end of all activities, each team will get to see their adult team leader in the ring against a Pedone’s Heavy Hitters skilled boxer. Once your adult team leader is in the ring, your team will be able to sit at the corner of the boxing ring to cheer your adult team leader on and make sure you keep him/her hydrated while they are faced with the Ultimate Challenge of competing against one of Pedone’s Heavy Hitters skilled boxers. This is the chance of a lifetime and an experience that you will remember not only because it was unique and so much fun, but because you supported your adult team leader and a wonderful cause in your community! Oh, and you can’t forget that there are also so many great prizes to be given away too!!!! So, get all of your paperwork to your adult leader by Monday, December 12th to reserve your spot in the event! Have your adult leaders contact Youth Infusion at (570) 266-5125 to confirm your spot and give us your team name by December 12th. All teams are required to bring their full registration fee ($250 per team) with them on the day of the event (checks should be payable to Youth Infusion, Inc.)

Got to for more information!

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Heavy Hitters TEAM MEMBER # ___________ VERY IMPORTANT: **Students must be 9 Years of age or older and **Must have 4 students and 1 adult per team **Additional Forms available online: or you can make copies of this form and just fill out the team member’s number (Example: Team Member #1, #2, #3, #4 or #5 with adult team leader being #1)

Registration Form TEAM NAME: _________________________________________________________________________ ADULT TEAM LEADER’S NAME:___________________________________________________________ Student’s Name: ___________________________________________Date of Birth_________________ Address: _____________________________________________________________________________ City/State: ________________________________________________Zip Code: ____________________ Home Phone: _____________________________________________Cell Phone: ___________________ Email (Print clearly): ____________________________________________________________________ School Name: _____________________________________________Grade: ______________________

Any Medical Conditions/Special Needs/Allergies: _____________________________________________ _____________________________________________________________________________________ Parent/Guardian: __________________________________Work Phone: _________________________ Email: ___________________________________________Cell Phone: ___________________________ Emergency Contact: ________________________________Phone: ______________________________

We are asking all teams to create their own Team T-shirts. There will be a really COOL prize for the Best Team T-shirt design!!!

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Heavy Hitters Challenge NOTICE OF RISK & LIABILITY RELEASE I hereby give permission for ___________________________ to participate in Youth Infusion, Inc. and Brian Pedone’s Heavy Hitters program(s) and/or activities. I recognize, understand and acknowledge that, as in all activities, there is always the inherent risk of injury up to and including death. I further agree and warrant that if I believe the conditions to be unsafe, I will immediately discontinue further participation in the activity. I recognize, understand and acknowledge that any and all rules, guidelines and safety procedures are established for the safety and protection of all participants and agree that my child(ren)/self will comply with all rules and policies involved with this program. I recognize, understand and acknowledge that my child(ren)/self will be expected to abide by the established rules, guidelines and safety procedures and to obey the staff, assistants and all staff members assigned to direct this program. I certify, to the best of my knowledge, that the current physical condition of my child(ren)/self is satisfactory for participation. I also certify, to the best of my knowledge, that my child(ren) is free of any health problems which would jeopardize participation. I will notify the staff immediately should the above condition change at any time during participation in the program, and that, upon request, I will furnish proof of current physical examination. I recognize that failure to comply with the above-mentioned items could result in immediate suspension and/or dismissal from the program and activities. The staff and/or sponsors have my permission to have a physician and/or emergency medical service treat and/or transport my child(ren)/self, if needed, at any time during participation in the program(s) on the registration form. In consideration of participation by my child(ren)/self in the program(s) on the registration form, I, the undersigned, do hereby agree to hold harmless and indemnify Youth Infusion, Inc., and Brian Pedone’s Heavy Hitters, its agents, servants and employees against any claims for and on account of any and all injuries sustained by my child(ren)/self as a result of participation in the above-mentioned program, including, but not limited to, claims on account of any negligence by Youth Infusion, Inc. and Brian Pedone’s Heavy Hitters or any of its employees, agents or subcontractors. Youth Infusion, Inc. and Brian Pedone’s Heavy Hitters have a zero tolerance policy with regards to the use of controlled substances, tobacco products, alcoholic beverages, weapons and vulgar language. The staff and/or sponsors have my permission to use and publish photographs of my child(ren)/self in any and all of its publications, advertising and promotional materials through any type of media, whether printed, electronic or otherwise. I understand that these photographs and videos may be used in future promotional and marketing materials such as brochures, flyers, public press releases and Youth Infusion, Inc.’s and Brian Pedone’s Heavy Hitters website. I hereby authorize Youth Infusion, Inc. and Brian Pedone’s Heavy Hitters to edit, alter, copy, exhibit, publish or distribute these photographs and/or other media formats for purposes of marketing and advertising Youth Infusion, Inc’s and Brian Pedone’s Heavy Hitters programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, where my child(rens) likeness appears. I have read the Notice of Risk and Liability Release and understand the terms. Adult/Parent/Guardian Signature: __________________________________ Date:______________________ Adult/Parent/Guardian Name (Printed): ___________________________________________

*A Parent or Guardian must sign for anyone under the age of 18 years of age*

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PRIZES 1ST Place Team FREE membership to Pedone’s Heavy Hitters Gym for 6 Months And 1st Place Medal Awarded

2nd Place Team FREE membership to Pedone’s Heavy Hitters Gym for 4 Months And 2nd place Medal Awarded

3rd Place Team FREE membership to Pedone’s Heavy Hitters Gym for 2 Months And 3rd place Medal Awarded

Other prizes include FREE T-shirts and surprise giveaways as well as plenty of Gift Certificates to your favorite places throughout the community!!!!!

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Your Checklist Create a Team of 4 friends/classmates plus 1 adult Create a Team Name Make Team T-shirts to receive COOL prizes Raise $50.00 each team member Return the following forms to your Team’s leader by December 12, 2011  Registration Form  Release Forms Adult Team Leaders must fax forms back to 888-569-3546 that same day Arrive at 11:30 am Sharp on Event Day for Registration!  Adult team leader will bring registration fee for their team Pass out fliers to all your family and friends so they can come out and cheer you on!

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Heavy Hitters Challenge Fundraiser - TOOLKIT 2012  

Heavy Hitters Ultimate Challenge Fundraiser - TOOLKIT Join us on Saturday, January 21, 2012 - 12pm-3:30pm for our 2nd Annual Heavy Hitters...

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