Sunshine Elementary School

THE BEAR FOOT 5K RUN

Saturday, April 16, 2011

Sunshine Elementary School

231 Toney Road Bostic, NC 28018

Event: 5K (3.1 miles)-8:30 A.M.

Fun Run (1/2 mile) 5th grade and under- 9:30 A.M.

All Fun Run participants will receive a medal.

Registration: $10.00 for middle school age and under, all others

$15.00 on or before April 8, 2011. $20.00 after April 9, 2011.

Fun Run: no charge but does not include shirt.

(T-shirt will be on sale for $10.00 at race)

**DO NOT REGISTER ON THIS FORM IF ONLY RUNNING FUN RUN. No registration or fee is necessary for Fun Run. **

Course Description: Fast, flat course thru scenic countryside.

T-Shirts: All 5K entries received on or before April 8, 2011, are

guaranteed a t-shirt. We cannot guarantee t-shirts to

late entries.

Awards: Top three male and female finishers overall, plus top three

male and female in each age group (5 and under, 6-7, 8-9,

10-11, 12-13, 14-15, 16-19, 20-24, 25-29, 30-34, 35-39,

40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-99)

Checks Made Payable To: Sunshine Elementary 5K Run (entry fees are non-refundable) Mail to: Jennifer Helton, 1357 Toney Road, Bostic, NC 28018

Director and Information: Jennifer Helton 828-247-0365

Name: ______

Address: ______Email______

City/State/Zip:______

Phone:______Emergency Contact Name & Number: ______

Age on April 16: _____ Gender: Male ___ Female ___

Shirt Size: Youth Small ___ Youth Medium ___ Youth Large___

Adult Small___ Adult Medium ___ Adult Large ___ Adult XL ___ Adult XXL ___

Athlete’s Release: In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, administration and assigns, release and discharge the sponsors and operators of The Bear Foot Run and their agents and employees from any and all claims for damages suffered as the result of my participation in or traveling to or from the said race to be held on April 16, 2011. I specifically release and discharge said operators and sponsors from all injuries or damages arising from or contributed to by any physical examination or other evidence of my fitness to participate in such event the same being my sole responsibility. I also give my permission for the free use of my name and picture in any broadcast telecast, newspaper, and/or other written account of the event.

Athlete’s Name ______

Parent’s Signature (if under age 18) ______