2024 HETRA Walk/Run Registration Form

Hoofin' it for HETRA
Charity 2K/5K Run/Walk

We are excited you have decided to join us on September 15th for HETRA's 3rd Annual Run at Gretna Crossing Park! This fun event includes a 2K & 5K route, as well as a 100-yard dash for the kids. The Kid's run will start right at 9:00 am, and runners & walkers will start at 9:15 AM. If you have any questions please reach out to us at 402-359-8830 or Kalynns@hetra.org.

T-Shirt & Packet Pickup:

Saturday, September 14th: 2:00 - 5:00 PM at HETRA - 10130 S. 222nd Street, Gretna - we will also be giving barn tours at this time if anyone is interested in meeting the horses!

Sunday September 15th @ Gretna Crossing Park, 21280 Capehart Rd, Gretna, NE 68028: 8:00 - 9:00 AM
Participant Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
Birthdate*

MonthDayYear
Date
T-shirt Size - T-shirts only guaranteed for those registered by August 31st.
Are you running on behalf of a HETRA participant? If so please enter their name below.
Age
Liability Release
First Name* Last Name* would like to participate in the Heartland Equine Therapeutic Riding Academy event. I acknowledge the risks and potential risks of this run/walk event. However, I feel that the possible benefits to myself/my son/my daughter/my ward are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Heartland Equine Therapeutic Riding Academy, its Board of Directors, Instructors, Therapists, Aides, Volunteers, and Employees for any or all injuries and/or losses I/my son/my daughter/my ward may sustain while participating in Heartland Equine Therapeutic Riding Academy Events.
Signature of Participant or Parent/Guardian*

Powered by Jotform SignClear
Participant, Parent, Guardian
Today's Date*
Photo Release
Please Check One:*

I do consent and authorizeI do not consent
the use and reproduction by Heartland Equine Therapeutic Riding Academy of any or all photographs and any other audiovisual materials taken of me/my son/my daughter/my ward for promotional printed, digital and web-based material, educational activities or any other use for the benefit of the program.
Signature of Participant or Parent/Guardian*

Powered by Jotform SignClear
Participant, Parent, Guardian
Today's Date*
Participant Name

First NameLast Name

My Products

2K Individual RunEnter description

$40.00

5K Individual Run

$40.00

2K Individual Walk

$40.00

5K Individual Walk

$40.00

Family Walk/RunEnter up to a family of 6 in the run or walk

$125.00

Kids 100 Yard Dash

$25.00

Virtual Runner/Walker

$25.00

Enter coupon

Total

$0.00

Participant #1 Race Selection
Family Participant Name #2

First NameLast Name
Family Participant #2 Birthdate

MonthDayYear
Date
Family Participant #2 Gender*
Participant #2 Race Selection
Family Participant #2 T-shirt Size - T-shirts only guaranteed for those registered by August 31st.
Family Participant Name #3

First NameLast Name
Family Participant #3 Birthdate

MonthDayYear
Date
Family Participant #3 Gender*
Family Participant #3 T-shirt Size - T-shirts only guaranteed for those registered by August 31st.
Participant #3 Race Selection
Family Participant Name #4

First NameLast Name
Family Participant #4 Birthdate

MonthDayYear
Date
Family Participant #4 Gender*
Family Participant #4 T-shirt Size - T-shirts only guaranteed for those registered by August 31st.
Participant #4 Race Selection
Family Participant Name #5

First NameLast Name
Family Participant #5 Birthdate

MonthDayYear
Date
Family Participant #5 Gender*
Family Participant #5 T-shirt Size - T-shirts only guaranteed for those registered by August 31st.
Participant #5 Race Selection
Family Participant Name #6

First NameLast Name
Family Participant #6 Birthdate

MonthDayYear
Date
Family Participant #6 Gender*
Family Participant #6 T-shirt Size - T-shirts only guaranteed for those registered by August 31st.
Participant #6 Race Selection

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Liability Release

Photo Release