Halstead Old Settlers Fun Run Registration

Full Name*

PrefixFirst NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

Gender

MaleFemale

Age Division*

**T-shirt Size

** Registrations must be in by Aug. 1st in order to receive your preferred tshirt size. Same-day registration tshirts available on a first-come, first-serve basis.

Additional Participants (17 and under)

Additional Shirts

Please include any additional shirt sizes and amounts here. Registration for 12 and under category does not include a t-shirt. If you would like to add a t-shirt for your child they are $10 each.

Cost: $25 per person/$15 for ages 12 and under. Day-of registrations can be cash or check payable to: Halstead Old Settlers

Registration Site: Kansas Learning Center for Health, 505 Main St. Halstead, KS 67056. Registrations will be taken at the Kansas Learning Center from 6:30 am until prior to the start of events.

Awards: Awards will be given at the completion of the 5K and will be presented at the finish line area.

ELECTRONIC SIGNATURE: As an participant in the Old Settlers Fun Run, I assume complete responsibility for any injury to me or particpants listed on my form or damage to my/our property which may occur during the event or while I am on the premises of the event; and I hereby release and hold harmless the sponsors, promoters and all other persons associated with the event from any and all liability for injury or damage, whether caused by negligence of the sponsors, promoters or other person associated with this event.

Signature

Registration Fee

Adult Registration$25.00

Quantity

Child Registration (12 and Under)$15.00

Quantity

Additional T-shirts $12.00

Quantity

Total $0.00

Fun Run 5K Walk/Run