Steve Weatherford’s 4th Annual “Rush the Punter” 5K Dash – Kids Fun Run Saturday, April 11, 2015 Fairbanks Park – front of YMCA Bldg. 9:00 AM – Kids 1 Mile Fun Run (K-3 grades) 9:30 AM – Kids 1 Mile Fun Run (4-8 grades) 10:00 AM – 5K Dash/Walk Registrations must be postmarked no later than March 27, 2015 to receive a race t-shirt. Entry is NON-REFUNDABLE. All participants will enjoy on course entertainment, chipped timing by Timing MD. Kids will receive a finishers medal. REGISTER ON-LINE AT: https://getmeregistered.com/RushthePunter 1. SELECT EVENT Event On time Late Registration (postmarked by 3/27/15) (by 4/6/15) � 5K Dash $20.00 � Runner � Walker 5K runners will begin first. Walkers will follow. $25.00 $ _________ � Kids 1-Mile Fun Run $10.00 � K-3 Grade Fun Run (8:30 AM) � 4-8 Grade Fun Run (9:00 AM) $15.00 $ _________ Total: $ _________ All race registration forms must be received by April 6, 2015 2. REGISTRATION INFORMATION (One form per participant) First Name: ___________________________________________ Last Name: _____________________________________ Mailing Address: ________________________________ City: ___________________________ State: ____ Zip: _________ Male � Female � Age on Race Day: ______ Grade: _______ School (if applicable):_______________________________ (Please note – If you sign up under a Vigo Co. School, all race packets will be delivered to that school on Friday, April 10) Adult T-Shirt Size* (circle): S M L XL XXL │ Youth T-Shirt Size*: YS YM YL *shirt sizes are not guaranteed E-Mail: ____________________________________________________ Phone # __________________________________ 3. LIABILITY WAIVER (Please read carefully and sign below) I do hereby relinquish all liability toward the United Way of the Wabash Valley, Vigo County School Corporation, City of Terre Haute, Terre Haute Parks Dept., event sponsors and event volunteers for any damages that may happen to occur during this event. I also understand there are no refunds of fees. __________________________________________________ ______________ Signature (if under 18 years of age, parent or legal guardian must sign) Date Mail this entire form and make checks payable to: United Way of the Wabash Valley, c/o Rush the Punter 2901 Ohio Blvd. Suite #215, Terre Haute, IN 47803 TITLE SPONSOR: For more information call the United Way Office at 235-6287 GOLD SPONSORS: Coldwell Banker - Crossroads Cafe/Corner Grind – Subway - Sun Factory Tanning - Thompson Thrift 5K participants compete in the following Male and Female age groups: Under 19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+