Rupert's Survival 5k Run Challenge 7/25/20

ONE FORM PER PARTICIPANT (unless choosing family option)

Join us for Rupert's Survival 5K Run Challenge
Shelby County Fairgrounds in Shelbyville, IN 46176

Run, jog, or walk a course full of obstacles and challenges for ALL ages. You might even go toe-to-toe with Rupert himself! 
Registration includes: T-shirt (tie-dye of course) if registered by 7/9, a one-of-a-kind finisher medal and a sack lunch.

Must register before 7/9/19 to have shirt included with your registration!  SAVE $5 when you register by 6/27/20!  

*NEW* Virtual Race option!  For those who are new to "virtual racing," it just means that you can complete your Survival 5k Run Challenge on your own time, from anywhere you'd like and we will mail you your race packet including shirt and medal!  (The packets will be mailed out approximately 1 week after the race, plenty of time for you to get the challenge in).

Plus 100% of proceeds will go to RUPERT'S KIDS -a nonprofit organization geared toward helping youth and young adults become active members of society.

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* 1. Contact Info

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* 2. Cost: price increases $5 after June 27, 2020

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* 3. Shirts (included if registered by 7/9)

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* 4. If you purchased a family rate, please include the name, age and shirt size of the other 3 participants!

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* 5. Event Waiver: 
By signing this form (for myself and/or the above named participant(s), I hereby waive, release, discharge, indemnify and hold harmless Rupert's Kids, its employees, agents and volunteers, and Shelby County Fairgrounds, its employees, agents, and volunteers, from any and all liability, claims, demands, causes of action, and possible causes of action whatsoever arising out of or related to any loss, damage or injury that may be sustained by  participating in this event.

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* 6. PHOTO RELEASE: 
I grant permission for photographs of myself and/or the above mentioned participant(s) to be taken at this event.  I agree the photographs may be used for publicity for Rupert's Kids on any media outlet.  

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* 7. Waiver Signature (If the participant is under 18, a parent or guardian must accept)

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* 8. How did you hear about this event?

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* 9. Payment (registration is not complete until payment is received)

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