Féileacáin (Stillbirth & Neonatal Death Support)

The Butterfly Run

Participant Name

First Name*

Last Name*

Email Address *

Home Address

Address Line 1*

Address Line 2

Town*

County *

Postcode*

Country*

Phone Number *

Emergency Contact *

Please provide a name and number for an emergency contact, as well as their relation to you:

Registration Fee - Adult *

One Adult (€15)

Two Adults (€30)

Family Ticket (2 Adults and 2 Children) (€35)

Registration Fee - Children

One Child (€5)

Two Children (€10)

Three Children (€15)

Four Children (€20)

Ages of Children

If any children are registered to take part, please add their ages here.

Purchase a T-Shirt

T-shirts purchased can be picked up at the run location on the day.

One (€5)

Two (€10)

Three (€15)

Four (€20)

Five (€25)

Six (€30)

Seven (€35)

Eight (€40)

Please Provide Your Required T-Shirt Sizes:

Please provide your desired t-shirt sizes below, we will do our best to accommodate. Kids T-Shirt Sizes:S (Age 5-6), M (Age 7-8), L (Age 9-11),XL (Age 12-14) Adult sizes: S, M, L, XL, XXL

Is there anything the event organiser need to be aware of to support your safe participation on the day? *

Yes

Participation Declaration *

I understand that participation in the Butterfly Run involves physical activity. I confirm that I am participating voluntarily and will take responsibility for deciding whether I am fit and able to participate. I agree to follow reasonable instructions given by event organisers and stewards.

I give Féileacáin the right to use any photographs taken in social media *

Baby's Name

If you wish, you may leave the name of the baby or babies you are running in memory of here.

Create a Fundraising Page on iDonate?*

Select whether or not to create a fundraising page on iDonate during submission.

I would like to receive updates from Féileacáin (Stillbirth & Neonatal Death Support).

I have read and agree to the Privacy Policy and Terms & Conditions of iDonate.