HUNTINGTON PLACE ELEMENTARY
Entry Form
Dear Parents,
Huntington Place Elementary will host a 5K and One Mile Pumpkin Run on Saturday,
October 28 at 10:00 a.m. The money raised will go towards a new Sound System for the gym and classroom needs. It will be a fun event for your entire family. All runners that register for the 5K before October 6th will receive a $5.00 discount. The registration fee will be $20.00. After October 6th the fee will be $25.00. The first 50 participants that sign up for the 5K will be guaranteed a t-shirt. There will be 1st, 2nd and 3rd place medals in all age categories for the 5K only.
Also, the students may ask family and friends for donations for the run. The class that brings in the most donations will have a Chick-fil-A party. Any student that brings in $100.00 or more in donations will have their name on the back of the 5K t-shirt. The deadline for donations will be October 6th.
There will also be a One Mile Pumpkin Run. Students may wear their costumes for the One Mile Run. Registration fee will be $10.00. All one mile pumpkin run participants will receive a Ribbon. Make checks payable to HPES and include two phone numbers and a driver’s license number.
5K T-Shirts will also be available for $15.00. Please fill out form below. Deadline to order
t-shirts is October 6th.
Please contact Huntington Place Elementary at 342-2652 or if you have any questions.
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5K & ONE MILE PUMPKIN RUN
ENTRY FORM
Name: ______Teacher ______Sex: M F
Street Address: ______
City: ______State: ______Zip:______
Phone: ( ) ______Shirt Size: AS AM AL AXL AXXL YM YL 5K ______$20.00 on or before October 6 Check or Cash
5K ______$25.00 after October 6 Check or Cash
One Mile Run _____$10.00 Check or Cash (Does not include t-shirt)
Age: ______(as of date of race) Date of Birth (MM/DD/YYYY) ______
I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge the Sponsor, and any and all other supporting groups of this said racing event, together with all of their officers, agents, officials, and employees from any and all liability, claims, demands, actions or cause of action whatsoever arising out of, or related to, any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event. I further state I am in proper physical condition to participate in this event.
SIGNATURE: ______Date:______
(Parent or guardian’s signature if entrant is under 18 years old)