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Underhill ID School PTO

Halloween Hustle Entry Form

Date: Saturday, October 17th, 2015

Location: Underhill ID School, Jericho

Times:

9:00: Race day registration & sign in

10:00: 1 Mile Fun Run/Walk

10:30: 5k Running Race

Name: ______________________________ Name: ______________________________

Age: __________ Sex: __________ Age: __________ Sex: __________

Event: 1 Mile or 5 K Event: 1 Mile or 5 K

T-Shirt Size: Adult or Youth T-Shirt Size: Adult or Youth

S M L XL S M L XL

Name: ______________________________ Name: ______________________________

Age: __________ Sex: __________ Age: __________ Sex: __________

Event: 1 Mile or 5 K Event: 1 Mile or 5 K

T-Shirt Size: Adult or Youth T-Shirt Size: Adult or Youth

S M L XL S M L XL

Address: ___________________________________________________________________

City: _____________________________________ State: _______ Zip: _______________

Phone: ____________________ E-mail: _________________________________________

Waiver: Knowingly, I am entering the UID PTO Halloween Hustle 5K running race or 1 mile fun

run/walk and I have adequately trained for this. I understand that the race may be held under adverse

weather conditions. Should I become injured from this event I assume all risks and will not hold the

sponsors, administrators, Underhill or Jericho, VT, or volunteers responsible.

______________________________________________ ____________________

Signature of Athlete or Parent/Guardian if under 18 Date

Please make checks payable to: UID PTO $15 Adult Pre-Registration

and send to: Nan Campbell – Race Director $20 Adult Day of Race Registration

46 Sugar Hill, Underhill, VT 05489 $10 Student (Pre-K-12) Registration

uidpto@gmail.com 858-9141 Total Enclosed: _____________

3rd Annual UID PTO

Halloween Hustle 5k Race & 1 Mile Fun

Run/Walk