May the Fourth Be With You 5K Fun Walk and Run

May 4th

Peru Riverwalk

$20.00 per participant

Registration 8am-Start Time 9am

Costumes and Light Sabers are encouraged!

Early Registration by April 25th to guarantee shirt size

Sponsorship Form:

Business Name:____________________________

Amount:___________________________________

$500 Event Sponsor

$100 T-shirt Sponsor

$50 In Memory of Sponsor: _______________________

All proceeds to benefit Riley Hospital and Kiwanis Local Scholarships

May 4th Peru Riverwalk $20.00 per participant

Registration 8am-Start Time 9am

Costumes and Light Sabers are encouraged!

Early Registration by April 25th to guarantee shirt size

Name:____________________________________

Address:__________________________________

Shirt Size:_______

Proceeds to benefit Riley Children’s Hospital and local scholarship.

Waiver and Release: We, the Participant and the Guardian, Release and forever discharge and hold harmless Nonprofit and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the activities as a participant with the Nonprofit, including claims arising out of negligence. We understand and acknowledge that this Release Discharges Nonprofit from any liability or claim that we may have against Nonprofit with respect to bodily injury, personal injury, illness, death, or property damage that may result from the Participant’s involvement in the Nonprofit’s activities.

Signature:___________________________________________________ Date:__________________

Mail form to Brooke Robertson at 13 E. Main St. Peru, IN 46970

Or drop off at CRC Building 13 E. Main St.