DITCH THE WORKOUT AND JOIN THE PARTY! BE A SUPERHERO 4 THE ARTS!

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Chester Bruce
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1 YOUNG AUDITORIUM S 2 nd ANNUAL ZUMBATHON 4 the Arts! DITCH THE WORKOUT AND JOIN THE PARTY! BE A SUPERHERO 4 THE ARTS! About the Fundraiser: Young Auditorium s Arts4All Program is excited to host its 2 nd annual Zumbathon! Arts4All provides students from economically disadvantaged backgrounds with the opportunity to attend performing arts events at a reduced price as a part of their educational experience. Studies show that when students participate in the arts, they benefit both academically and socially. Participation in the arts also contributes to an individual s overall health and wellbeing. All proceeds from this event will directly support the Horizons Arts4All program. About Zumba : Zumba is a Latin-inspired dance fitness program that combines aerobics and dance. It features salsa, hip-hop, samba, and merengue, among other genres. All genders, races, and ability levels and ages* are welcome to participate. No experience necessary! Come and dance, exercise and party at your own pace. Certified Zumba instructors with Fort HealthCare, Tiffany Frohmader and Wendy Schreiner, will lead this 2-hour fun-tastic event! When and Where: Zumbathon 4 the Arts will be on Sat. May 10, 2014, 10am-12pm on stage at Young Auditorium, UW-Whitewater 930 W. Main St. Whitewater, WI Same day registration begins at 9am. This is how it works! There are several options you can choose from that are listed below. Please select your option and follow the guidelines. Option 1: Pre-registered Individual Pre-register with this form and pay $20. Students with valid ID pay $15. Option 2: Pre-registered Team Pre-register as a team (max. 5 people) and pay $75. Option 3: Fundraising Individual or Team Go out and get donations from area businesses, friends, family, co-workers, and neighbors to raise as much money as you possibly can to help provide Arts4All. Individuals who raise at least $50 will get free admission to the event AND a free raffle ticket for the prize drawings. If your team collectively raises at least $200, each member of your team will receive free admission to the event PLUS a free raffle ticket each for the prize drawings. Option 4: Register at the Door - Individuals may register at the door for $25. T-shirts and Prizes The first 50 participants will get a free T-shirt! Additional T-shirts will be available to purchase for $5 (subject to availability). Raffle prizes donated by local businesses will be awarded at the end of the 2-hour event! Raffle tickets cost $2 each or 3 for $5. Other Fun (non-required) Stuff This year s theme is Be a Superhero 4 the Arts! We challenge you to dress the part think sweatbands, wristbands, even capes! Teams may want to identify themselves by wearing unified colors. Be creative,

2 but be sure that your gear will still allow you to move freely and stay safe. Prizes will be awarded for best costumes. Timeline of the day! 9:00 am DOORS OPEN! Registration begins. Sign waivers, check in, receive your T-shirt and enter raffle drawings. 9:45 am - Welcome 10:00 am Sizzling hot 2-hour Zumbathon with Tiffany and Wendy (Don t worry - you can take breaks if you need to!) 12:00 pm Cool down and raffle prizes! (Must be present to win) Name: Address: Phone: Tshirt Size XS S M L XL XXL YES I am pre-registering and enclosing my signed waiver and a check for $20 (Payable to University of Wisconsin-Whitewater) YES I plan to raise over $50 (no money due at this time; bring money to the event but send in your registration form and signed waivers today). A SPONSOR PLEDGE FORM IS AVAILABLE ON OUR WEBSITE. YES I am pre-registering for a group of up to 5! Enclosed are signed waivers and a registration form for each person and one or multiple checks totaling $75 for our entire group! (Payable to University of Wisconsin-Whitewater) YES Our team plans on raising over $200 (no money due at this time; bring money to the event but send in your registration form and signed waivers for each person on your team today). A SPONSOR PLEDGE FORM IS AVAILABLE ON OUR WEBSITE. PRE-REGISTRATION DEADLINE IS FRI. MAY 2, 2014 Please mail or drop off this registration form and payment (make checks payable to UW-Whitewater) to: Young Auditorium Attn: Shannon Dozoryst Zumbathon 930 W Main St Whitewater, WI If you have questions, please contact Shannon Dozoryst at Thank you! YOU MUST SIGN THE INCLUDED WAIVER IN ORDER TO PARTICIPATE IN THE ZUMBATHON EVENT!

3 Agreement for Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment I, (print name), age, desire to participate voluntarily in the University of Wisconsin Whitewater Arts 4 All Zumbathon on Sat. May 10, I UNDERSTAND THAT I AM BEING ASKED TO READ EACH OF THE FOLLOWING PARAGRAPHS CAREFULLY. I UNDERSTAND THAT IF I WISH TO DISCUSS ANY OF THE TERMS CONTAINED IN THIS AGREEMENT, I MAY CONTACT: RISK MANAGEMENT AND SAFETY AT (262) Assumption of Risks: I understand that not all risks can be foreseen and there are some risks which are unpredictable. I understand that certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I am aware of the risks of participation, which include, but are not limited to, the possibility of physical injury, fatigue, bruises, contusions, broken bones, concussion, paralysis, and even death. I understand that the university has advised me to seek the advice of my physician before participating in the above named program. I understand that I have been advised to have health and accident insurance in effect and that no such coverage is provided for my by the University or the State of Wisconsin. I know, understand, and appreciate the risks that are inherent in the above-listed programs and activities. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. Signature: Date: Hold Harmless, Indemnity and Release: In consideration of my participation in these activities, I, for myself, spouse, heirs, personal representatives, estate or assigns, agree to defend, hold harmless, indemnify and release the Board of Regents of the University of Wisconsin System, the University of Wisconsin-Whitewater, and their officers, employees, agents, volunteers, and all others who are involved, from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from my participation in the above-listed program. This release includes claims based on the negligence of the Board of Regents of the University of Wisconsin System, the University of Wisconsin- Whitewater, and their officers, employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or gross negligence. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including my right to sue. Signature: Date: Consent for Emergency Treatment: I authorize the University of Wisconsin-Whitewater and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization. Signature: Date: *If your son, daughter or ward will be under 18 while participating, it is our policy to request your agreement to the above terms on behalf of your minor son, daughter or ward. 4/7/2010

4 PRE -REGISTRATION DEADLINE IS MAY 2, 2014 Please mail or drop off this registration form and payment to: Young Auditorium Attn: Shannon Dozoryst Zumbathon 930 W Main St Whitewater, WI Make checks payable to University of Wisconsin - Whitewater If you have questions, please contact Shannon Dozoryst at Thank you! YOU MUST HAVE FILLED OUT A REGISTRATION FORM AND SIGNED THE WAIVER IN ORDER TO PARTICIPATE IN THE ZUMBATHON EVENT! Sponsor s Name Print Clearly Sponsor s Address Complete Mailing Address Paid Pledge Paid (circle) Cash Check

Rock Band Pre-Camp Information Check In: Time: 11:00 12:00pm, resident and commuter campers Location: Arey Hall, 1024 W. Starin Road, Whitewater, WI

Rock Band Pre-Camp Information Check In: Time: 11:00 12:00pm, resident and commuter campers Location: Arey Hall, 1024 W. Starin Road, Whitewater, WI Check-Out: Time: 5:30-6:00pm Location: Arey Hall Important