Event Signup - Kirby Dash

Come join us for the annual Cock-A-Doodle Dash fundraiser!

Kirby Club Members race (1/4 mile), eat and get a t-shirt for free!
Are you an adult looking to participate in the 5k or 1 mile walk? Learn More.

Event
Quarter mile race for ages 12 and younger
Entry fee, breakfast and race t-shirt will be provided to Kirby Club Members.
Adult breakfast and open house $7.

When: Saturday May 9, 2015
Check in: 7:30 am - 8:30 am
Cock-A-Doodle Dash start: 8:30 am
Open House: 9:15
am
Where: Illinois Farm Bureau - 1701 Towanda Ave. - Bloomington, IL 61701

Reservations by May 1st are required for your Kirby Club Member's entry fee to be paid by IAA Credit Union.
Please fill out the form below or give us a call at 309-557-2541.

Age at time of race
T-Shirt Size









All race participants will receive breakfast with their entry fee. For those adults who are not racing, it will be $7 per person.

Electronic Signature




PLEASE READ CAREFULLY. THIS LEGAL DOCUMENT AFFECTS YOUR RIGHTS.
​In consideration of myself and/or my child being permitted to participate in the Illinois Farm Bureau Foundation’s 5K Grow and Go (the “Event”), and in full recognition and appreciation of the dangers and risks inherent in such participation, I freely and voluntarily execute this Release of Liability (“Release”) under the following terms:

Assumption of the Risk. I understand that participation in the Event is voluntary and involves activities that may be hazardous and may cause physical injury, permanent disability or death. I expressly and specifically assume responsibility for all known or unknown risks of injury or harm related to such participation.

Release and Waiver. I, personally and on behalf of my below named child, heirs, assigns, executors and administrators (and for any other party who may claim under or through me), release, discharge, and hold harmless the Illinois Farm Bureau Foundation and their agents, employees, officers, directors, members, successors, assigns, and affiliate organizations, including without limitation parents and subsidiaries, (collectively the “Released Parties”) from all liability, claims, actions, and demands which may arise from or relate to participation in the Event. I understand I am discharging the Released Parties from any liability or claim that may exist against them with respect to any injury, illness, death, or property damage that may result from participation in the Event, whether caused by the negligence of the Released Parties or otherwise.

Other. I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Illinois. I agree that in the event any part of this Release is held to be invalid by any court of competent jurisdiction, such invalidity shall not otherwise affect the remaining parts of this Release which shall continue to be enforceable.
Upon accepting my application and in consideration of allowing me to enter this event, which I agree is at my own risk and entirely of my own free will I hereby for myself and on behalf of my heirs, executors, administrators, and assigns, waive, release, and discharge Illinois Farm Bureau, IAA Foundation, Illinois Agriculture in the Classroom, IFB Family of Companies, Lake Run Club, race organizers, race volunteers, sponsors, and promoters from any responsibility or liability whatsoever for any losses, injury, or other damage sustained in any activities during or surrounding the event. I also give permission for the free use of my name and picture in the any broadcast, telecast, or print media account of this event or subsequent similar future events.