Brantley County Special Education Program
presents
2016Heron Hustle 5K & Fun Run
Proceeds to benefit Brantley County Special Olympics and Special Education Program
TIME:Registration Opens—7:30am 5K—8:30am Fun Run –9:30am Awards-- 10:00am
PLACE: Nahunta Primary/Elementary Gym; Hwy 301; Nahunta, GA
ENTRY FEE: $20.00 for the 5K Run/Walk $10.00 for Fun Runby April 14th, 2016 (Non-refundable)
$25.00 for the 5K Run/Walk $15.00 for Fun Run after April 14h, 2016 and Day of Race
T-shirt guaranteed with early registration. Shirts available to entrants on race day as long as supplies last.
AWARDS: *Top overall male and female finishers and Top overall male and female masters “40+”
* Top 3 finishers in each age: 10 & under, 11-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-over
* Door Prizes
Information Contact: Roxie Tumlin or Wendy Lee; 912-462-6612;
Mail or drop entry forms off to: Please make checks payable to:
Brantley County BOE Sped Dept. Brantley County Sped Fund
272 School Circle
Nahunta, GA 31553
************************************Entry Form for HERON HUSTLE******************************************
First Name:______Last Name______Age: (on race day) ______DOB:______Gender: Male / Female (circle one) Phone:______Email:______
Mailing Address: ______
City: ______State/Province: ______Zip/Postal ______
I wish to enter the following event: ____5K - $20.00; after 4/14/16 & day of race- $25.00
____Fun Run $10.00; after 4/14/16 day of race $15.00
T-Shirt Size: (CIRCLE ONE) Toddler:_____Youth: XS S M L Adult: S M L XL XXL 3XL (add $2 for XXL and 3XL)
RACE WAIVER – PLEASE READ AND SIGN TO PARTICIPATEI know that running a road race is a potentially hazardous activity. I should not participate unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the event. I assume all risks associated with participating in this event, including, but not limited to, falls, contact with other participants, the effects of weather, traffic, and conditions of the road, all such risks being known and understood by me, having read this waiver and knowing these facts and in consideration of accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Brantley County Board of Education, Nahunta Primary/Elementary Schools, City of Nahunta, OTCC, Childers Family YMCA, event committees, and agencies and municipalities, their representatives, and successors for all claims or liability of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.
______
Signature of participant Date Signature of parent/guardian of participant under 18