Rupert's 5k Survival Dash *GONE VIRTUAL 2020

ONE FORM PER PARTICIPANT 

Join us for the 3rd Annual Rupert's 5K Survival Dash - VIRTUALLY!

Unfortunately, with the current state of the country, we have made the decision to switch our race this year to a virtual only option!  As sad as this is that we won't get to see everyone in person, we are excited for the opportunity for more participants throughout the country to join in on the fun and see what survival challenge you can come up with!

We are encouraging everyone to:
on Saturday- JULY 25 (weather permitting)
*Run, jog or walk your 5K*
*include survival challenge along the way (follow our Facebook page for some examples) but we would love to see what you come up with.  Think knots, puzzles, agility, balance, etc.
---be sure to send us videos and pictures to share.  Who knows, you may even get a shout out from Rupert himself or we may use your idea for our course next year!

EVERY PARTICIPANT WILL RECEIVE:
* An exclusive race T-shirt
* An exclusive finisher medal
* A signed photo from Rupert & Laura
* A copy of Rupert's book- Rupert: Just Being Me
ALL MAILED DIRECTLY TO YOU!

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.  *A TRUE re-entry program that demonstrates the value that justice reform will bring.

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* 1. EVERY PARTICIPANT WILL RECEIVE:
* An exclusive race T-shirt
* An exclusive finisher medal
* A signed photo from Rupert & Laura
* A copy of Rupert's book- Rupert: Just Being Me

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* 2. Contact Info (use shipping address)

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* 3. Cost:

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* 4. Shirt size

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* 5. I would like to purchase additional T-Shirts ($20 each)

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

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* 8. Waiver Signature (If the participant is under 18, a parent or guardian must accept) Type name for agreement

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* 9. How did you hear about this event?

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

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