Big Brothers Big Sisters www.bbbsgreensburg.org This race is a FUNDRAISER for Big Brothers Big Sisters of Decatur County. WHERE: Rebekah Park–Parking available at Greensburg HS WHEN: Saturday, June 13th, 2015 10:00 a.m. ENTRY $25 / Early Registration April 1 to May 15 (includes T-Shirt) FEE: $30 / Late Registration starting 5-16 (T-Shirt not guaranteed after 5-31) Free / Youth 8 & Under (1 child per paying adult, $5 for additional child. T-shirt additional $10 if desired. Entry fees support youth mentoring relationship programs for the agency. Web: bbbsgreensburg.org / 812-663-7556 Wednesday, June 10; Thursday, June 11; Friday June 12 Registration Materials PICK-UP DATES: 4:00 to 6:00 pm or Saturday morning beginning at 8:00 a.m. ————————————————————————————————————————————— BIB No.’s _____ # Paid T-SHIRTS _____ Paid Adult $_____________ Paid Child $_____________ PayPal $_____________ ENTRY FORM Make checks payable to: “Big Brothers Big Sisters of Decatur County” Mail to: Big Brothers Big Sisters of Decatur County—P.O. Box 301, Greensburg, IN 47240 (Registration and Payment thru PayPal can be made “on-line” at bbbsgreensburg.org) Adult Name _______________________________________________________________________________ Childs Name: One (1) Child Only per paying Adult: _______________________________________ Age____ Address _____________________________________City _______________________State_____ Zip______ Phone ________________________ Email ______________________________________________________ Emergency Contact Name & Number___________________________________________________________ Shirt Size (adult) __S__M__L__XL__2X__3X (included with Paid EARLY Registration) Youth - ___YS ___YM ___YL ($10.00 each to be Paid in Advance) CANCELLATION WAIVER: The participant acknowledges that the registration is only a license to participate in the event. There is not guarantee as to quality or any element of the scheduled event, that the scheduled event may be cancelled, shortened or altered due to weather, other acts of God, terrorism, or for any other reasons within or not within the control of Big Brothers Big Sisters of Decatur County in whole or in part, and there are no refunds for any reason whatsoever, and the registrant understands that these terms are a condition of the entry fee and agrees to register subject to these terms. WAIVER AND RELEASE OF LIABILITY: Entry invalid if not signed. By participating in the Big Brothers Big Sisters “5K Color Fun Run”, I for myself, all my children, my executors, administrators and assigns, do hereby release and discharge Big Brothers Big Sisters of Decatur County and all cooperating businesses and organizations from all claims of damages, demands, actions and whatsoever, in any manner arising or growing out of my participation, or that of all my children in this event. I agree to allow photograph(s) and brief description(s) for recruitment or public relations efforts in any way they deem necessary without remuneration or compensation, and release BBBS of Decatur County, Inc, from any and all liability, known or unknown in connection with the use of such photograph(s) and brief description(s). I certify that I, and all my children are physically able to participate in this event. ____ By checking this box, I verify that I have reviewed all information above and agree to all terms. _____________________________________________________________ _______ Participant Signature (Parent/Guardian if under 18) Date