PHS 2nd Annual
“Supporting Autism around the World” 5K Walk/Run
Saturday, May 09, 2015
Patriot High School, Nokesville, VA
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Race Information:
The Interact Club of Patriot High School is proud to announce its 2 nd Annual “Supporting Autism around the
World” 5K Walk/Run! Come out for music and family fun, while walking/running through the beautiful grounds of
Patriot High and T. Clay Wood Elementary. Strollers are welcome but unfortunately please no 4 legged family
members (pets) this time!!
5K Proceeds: The Interact Club will be splitting the proceeds this year between a local organization which supports
Autism and an Interact Scholarship for the 2015-2016 school year.
Raffles and Such:
Patriot Interact Members will be selling raffle tickets and Autism Apparel prior to the race … while you are
enjoying the 5K, tickets will be drawn. When you have finished the 5K be sure to come back to the Raffle booth to
see if you are a WINNER!!!! We will also be having a 50/50 drawing. You won’t want to miss out on this fun!!!!
Attention:
We will not be timing the 5K, please feel free to bring your own stop-watch/timing device. We are sorry for this
inconvenience; we are truly trying to promote educational awareness. This is a family-friendly event to learn more
about Autism Awareness. Educational information will be provided throughout the course... take the time to learn
some interesting facts and get to know what ASD is all about!
T-shirts:
Available to 5K Participants who register by 12 P.M., April 24, 2015. We will be placing our order for the t-shirts
on the 25th of April … please be sure to register prior to 12 P.M., April 24th to be guaranteed a 5K t-shirt.
Race Packet Pick Up:
Friday, May 8th, 3:00-5:00 pm (Patriot High School Door 1)
Saturday, May 9th (race morning), 7-7:30 am, Patriot High School’s Stadium area.
Thank you to our Amazing Sponsors: Chick-fil-A at Bristow; Atlas LC, Heating & Air Conditioning; The
Running Store; Bull Run Academy of Gymnastics; DJ Dove Inc.; Real Business Solutions LLC; Battlefield Ford of
Manassas; Han’s Haymarket, Inc.; The Bone BBQ; and The Baldwin Group, Inc.
Name ____________________________________ Race Day Age_________
Gender _________
Address ___________________________________________________________________________
City ___________________________________________
Phone (_______) ____________________________
Grade __________
Zip _________
Email _____________________________
Teacher (if at Patriot High School) ______________________________
(
T-Shirt Size:
State____________
) $10 Student
(K-12th grade)
Youth S ( ) Youth M ( ) Youth L ( )
Adult S ( ) M ( ) L ( ) XL ( ) XXL (
) $20
(
) XXXL (
Adult
)
Waiver: In consideration of the acceptance of this entry for the 2nd Annual “Supporting Autism around the World” 5K Walk/Run, I waive all claims for
myself, my heirs, and assigns against Patriot High School, Patriot High School Interact Club, and all race sponsors and personnel for any injury or illness,
claims or damages which may result from my participation. I further state that I am in proper physical condition to compete in this race. I understand that
the 5K walk/ run is held rain or shine, however it may be cancelled should adverse weather conditions arise. Registration is final; no refunds will be given.
Signature _____________________________________________ Date_________________
(Parent or guardian signature for participants under the age of 18)
MAKE CHECKS PAYABLE AND RETURN ENTRY FORM TO:
Patriot High School Interact Club, 10504 Kettle Run Rd., Nokesville, VA 20181
For more information, email [email protected]