Bushland Beat
SUPER HERO - 10K/5K/Fun RuN
April 18th - 6:00pm - Bushland high school
___ 10K run - $40 ___ 5K Run - $30
___ 1 mile fun run $20 ____ virtual run $30
One registration form per participant! Additional registration forms can be picked up at Bushland Elementary.
Forms are due back by March 30th to guarantee a T-shirt!
Paper registration deadline is April 14th!
Name: ___________________________
Age:_______________Male: ______Female: _______
Address: ___________________________City:_____________________ST________Phone___________
Register online at
until April 17th!
Unisex - Short Sleeve T-shirt: S M L XL XXL YS YM YL YXL (please circle your size)
In return for its agreement to accept this entry form, I hereby release Bushland Elementary PTO, its officers, directors, agents, representatives, and the volunteers,
sponsors, promoters, and all other persons associated with the PTO from liability for any injuries received by me (or if the participant is a minor, then I release them from
liability for injuries received by the minor for whom I am responsible) during participation in the sporting event, which includes all post-race activities through the end of
the awards ceremony and the conclusion of the event. I recognize that participation in the event sponsored or in any way supported by Bushland Elementary PTO
exposes me and/or my family member(s) to risk, including but not limited to running-related injury, traffic, and other risks including cracks in the roadway or sidewalk,
uneven running surfaces, slick conditions, other participants in the race, weather related hazards and post-race accidents of any type. Nothwithstanding these potential
risks and possibly other unanticipated risks, all of which cannot be listed, I HEREBY ASSUME FULL RESPONSIBILITY FOR ANY INJURY OR ACCIDENT WHICH MAY OCCURE
DURING MY (OR MY FAMILY MEMBER'S) ATTENDANCE OR PARTICIPATION IN THIS EVENT.
Signature ______________________________
Date: ______________________
(parent signature if under 18)
Please make check payable to: Bushland Elementary PTO
Forms may be returned to the front office of Bushland Elementary or mailed to PO BOX 231, Bushland, TX 79012
Any questions please contact: Erin Palacio - 806-570-2441 - [email protected]
Thank you for supporting the Super Heroes of Bushland Elementary
- our children, teachers and staff!