Underhill ID School PTO Halloween Hustle Entry Form Date: Saturday, October 14th, 2017 Location: Underhill ID School Times: 9:00: Race day registration & sign in 10:00: 1 Mile Fun Run/Walk 10:30: 5k Running Race Address:____________________________________________________________________ City: _____________________________________ State: _______ Zip: _______________ Phone: ____________________ E-mail:_________________________________________ $15 Adult Pre-Registration, by October 5th, guaranteed a free t-shirt $20 Adult Day of Race Registration, t-shirt not guarantee $10 Student (Pre-K-12) Pre-Registration, by October 5th, guaranteed a free t-shirt $10 Student (Pre-K-12) Day of Race Registration, t-shirt not guaranteed

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. Racer:____________________________________ Age:_______

Gender: M or F

Race: 1M or 5K

Racer:____________________________________ Age:_______

Gender: M or F

Race: 1M or 5K

Racer:____________________________________ Age:_______

Gender: M or F

Race: 1M or 5K

Racer:____________________________________ Age:_______

Gender: M or F

Race: 1M or 5K

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Signature of Athlete or Parent/Guardian if under 18

Date

T-Shirt Size (circle 1): XL L M S YL YM YS _________________________

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Signature of Athlete or Parent/Guardian if under 18

Date

T-Shirt Size (circle 1): XL L M S YL YM YS _________________________

__________

Signature of Athlete or Parent/Guardian if under 18

Date

T-Shirt Size (circle 1): XL L M S YL YM YS _________________________

__________

Signature of Athlete or Parent/Guardian if under 18

Date

T-Shirt Size (circle 1): XL L M S YL YM YS

Please make checks payable to: UID PTO mail check and form to: Underhill ID School, Attn: PTO, 10 River Rd, Jericho, VT 05465 [email protected] 858-9141 – Nan Campbell Feel free to photocopy this page.