2017 Dirty Ninja Mud Run For Kids™

(one form per participant)

Check One Entry Fees

Ages 4 - 6 March 1 - June 15: $25

Ages 7 - 8 June 16 - July 14: $35

Ages 9 - 10 July 15: $50

Ages 11 - 15

Child’s Name: ______________________________

Birthdate: _____________

Address: __________________________________

City: __________________ State: ____ Zip: ______

Phone: ___________________________________

Email: ____________________________________

T-Shirt Size (check one):

Youth: -XSm - Sm -Med - Lg - XL

Adult: - Sm -Med - Lg - XL

Knowingly and at my own risk, I hereby apply to enter the Dirty Ninja Mud Run For Kids™ and do hereby waive and release West Bend Parks, Recreation & Forestry, the City of West Bend, all representatives, all sponsors, all volunteers, all race director/staff, their subsidiaries, heirs and successors, agents and attorneys, from any and all claims of liabili-ties of any kind and character whatsoever arising from my participation in the event or my transportation to/from the event. I consent to the full use of my image in photos and videos for any legitimate purpose as regards the recording or future promotion of this event. I consent to the release of my event registration information to outside organiza-tions. I am physically fit and sufficiently aware of the risks involved in participation in walk/run events of this kind/distance and in any out-door activity with regards to weather, automobile traffic, pedestrian traffic, etc. I am aware that this event course is open to vehicular traffic during the event.

Signature of Parent or Guardian:

________________________________

Please make checks payable to: WB Parks & Rec. Mail to: 1115 S. Main St., West Bend, WI 53095

Registrations are non-transferrable and non-refundable.

Reg. Fee Paid: $ ________

Date: ________ Cash / Check # _________

Hosted By

Dirty Ninja

Mud Run for kids™

DIRTY NINJA

MUD RUN FOR KIDS™ The Dirty Ninja Mud Run For Kids™ is open to

kids ages 4-15 years old, who are looking for an

exciting, fun, and challenging run/walk.

Proceeds benefit the West Bend Recreation Division

Saturday, July 15, 2017

7:30 am Registration*

Ages 11-15: 9:00 am Start

1.5 miles with obstacles

Ages 9-10: 9:30 am Start

1.5 miles with obstacles

Ages 7-8: 10:00 am Start

1 mile with obstacles

Ages 4-6: 10:30 am Start

1/3 mile with obstacles

Start and Finish in Regner Park, located at 800 N Main St, West Bend, WI 53090. Start line is near the Beach House.

All finishers will receive dated commemorative medals at the finish line.

By mail: Please complete the attached form and mail with entry fee to:

City of West Bend

Parks, Recreation & Forestry

1115 S. Main Street,

West Bend, WI 53095

Please make checks payable to: WB Park & Rec.

In Person: Office hours are 8:00AM-4:30PM.

On Line: Registration is available online at: https://webtrac.ci.west-bend.wi.us/vsiwebtrac103.html

Entry Fees:

March 1 - June 15: $25

June 16 - July 14: $35

Day of Race - July 15: $50 (cash or check only)

Pre-registered participants may pick up race packets at the City of West Bend Parks,

Recreation & Forestry Department office

July 13-July 14 during the hours of 8:00AM-4:30PM or on the day of the event beginning at 7:30 am at the Regner Park Rotary Building.

Maps of the course will be provided in packets.

*Same day registration will open at 7:30 am on July 15th at the Regner Park Rotary Building.

Please register early to guarantee your spot and

requested t-shirt size.

What’s included in your entry fee:

A custom Dirty Ninja Mud Run For Kids™ head-band

A custom Dirty Ninja Mud Run For Kids™ t-shirt

The opportunity to participate in a great run/walk with fun, mud ,and challenging obstacles!

One (1) custom wristband for race entry and for swimming at Regner Beach on race day.

One (1) coupon for lunch available at Regner Park concession stand.

Special offers/goodies from our sponsors.

The opportunity to attend Regner Fest 2017!

Bounce houses, face painting, music,

& fun for the whole family.

How dirty will I get?

We guarantee participants will get dirty, wet, and sweaty. There will be at least two areas with sand or mud on each course. There are also shallow water features and a water slide. Participants will be climbing and crawling under, over, and through obstacles. At the end of the run, kids will have the opportunity to rinse off with a shower of water from a West Bend Fire Truck!

What should I wear?

We suggest wearing comfortable clothing and shoes (we recommend water shoes) that you don’t mind getting dirty. We also highly encourage cos-tumes!

What is the Weather/Refund Policy?

The event will be held rain or shine unless severe weather occurs. In the event of severe weather, the race may be delayed or cancelled. If the race is cancelled, there will be no refunds.

No claim is made to the exclusive right to use Dirty Ninja Mud Run for Kids apart from the mark as shown.