BE A HERO FOR KIDS:

BRUCE’S BIG BUTTE CHALLENGE FUN RUN

Sponsored by: Exchange Club of Butte and Big Brothers Big Sisters

In memory of Bruce Robinson

WHEN: Saturday April 15, 2017 at 10:00 a.m. DISTANCES: 1 Mile, 5k and 11k

ENTRY FEE: 14 and Under - $10 AND 15 & Over - $20 ($25 after April 8, 2017) *Entry Fee Includes T-Shirt

No guarantee for late or race day registrants, shirts will be given on a first come first serve basis.

MAIL FORM TO: Fun Run, P.O. Box 117, Butte, MT 59703 (checks payable to “Butte Exchange Club”)

PRE-REGISTRATION AND PACKET PICK-UP: Friday, April 14th from 5:00 pm – 7:00 pm at Metals Bank

FORMS & RACE INFO: www.butteexchangeclub.org, www.bbbsbutte.org & buttespissandmoanrunners.com

RACE DAY REGISTRATION: 8:30-9:30 a.m. – Montana Tech HPER Building Lobby, 1301 W. Park St, Butte

*Original Big Butte Challenge course

*No Race Day changes * Entry Fee is non-refundable *Race held regardless of weather conditions!

*Participants and/or Guardians Must Sign the Entry Form Below! *All kids must be accompanied by an adult. ----------------------------------------------------------------------------------------------------------------------------- -------------------------------------

Name ____________________________________________________ E-mail ___________________

Address ___________________________________________________ Phone ___________________

___ Male ___ Female Distance: ___ 1 Mile ___ 5k ___ 11k (No Walkers)

Adult T-Shirt Size: ___ XS ___S ___M ___ L ___ XL

Age:

___ 14 & Under ___ 15-19 ___ 20-29 ___ 30-39 ___ 40-49 ___ 50-59 ___ 60-69 ___ 70-79 ___ 80 & Over

WAIVER OF RESPONSIBILITY: In consideration of my being permitted to participate in the Be a Hero for Kids: Bruce’s Big Butte Challenge, I, the undersigned

participant, for myself, my heir, executors and administrators forever release and hold harmless the Exchange Club of Butte and Big Brothers Big Sisters of Butte-Silver

Bow, its agents, employees, successors and assigns, any of its distributors, or any person officially connected with this event from any and all claims, actions, losses, damages or expenses including attorney fees for bodily injury or personal property, incurred by me arising out of or in conjunction with the above mentioned race. I am

of legal age and capacity and have read and understood the contents of this release. I warrant that I am in good health, and that I have no physical condition which

would prevent me from participating in this event. I also agree to the use of my photo for publicity purposes in promoting the race. I understand that running is an action sport that carries significant risk of injury or death. Natural and manmade obstacles exist and conditions may vary constantly with weather changes.

Signature of Participant ________________________________________________________ Date _________________________ (parent or guardian if under 18 years of age)