HALLOWEEN HUSTLE FOR HOPE & TRICK OR TROT FUN RUN 5 K Race –and– 1 Mile Fun Run (under 12) Oct. 25, 9 AM-1:30 PM - Registration Form (one registration form per participant) Event (circle one): 5 K RACE 1 MILE FUN RUN (under 12) Full Name: __________________________________________ Age on Race Day: ______________________ Address (Street/City/State/Zip): _____________________________________________________________ Gender (circle one): Male Female Phone Number: ________________________________ Email Address: _____________________________ T‐shirt size (circle one): XS S M L XL XXL XXXL Early Bird Registra on Fee: $20 per runner/ $10 for kids under 12—$50 max for family registra on (use separate page for each individual) To receive a t‐shirt, please postmark your registra on by October 11th. Onsite registra on: $25 per runner / $15 for kids under 12 R ( “UM J A ”) : United Methodist Church in Northern Virginia Halloween Hustle, 5001 Echols Ave., Alexandria, VA 22311 Participant Waiver for Race/Run Registration I know that running a race is a poten ally hazardous ac vity, which could cause injury or death. I will not enter and par cipate unless I am medically able and properly trained and, by my signature, I cer fy that I am medically able to perform in this event and that I am in good health while being properly trained. I agree to abide by any decision of a race oﬃcial rela ve to any aspect of my par cipa on in this event, including the right of any oﬃcial to deny or suspend my par cipa on for any reason whatsoever. I assume all risks associated with running in this event, including but not limited to falls, contact with other par cipants, the eﬀects of the weather, including high heat and/or humidity, traﬃc, and the condi ons of the road, all such risks being known and appreciated by me. I understand that bicycles, skateboards, roller skates or roller blades, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these facts and in considera on of your accep ng my entry, I, for myself and anyone en tled to act on my behalf, waive and release the Halloween Hustle for Hope & Trick or Trot event coordinators, the United Methodist Church, United Campus Ministries, Fairfax County Park Authority, and the town of Reston, Virginia, as well as all event sponsors and their representa ves and successors from all claims or liabili es of any kind arising out of my par cipa on in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, mo on pictures, recordings or any other record of this event for any legi mate purpose. Signature: Date: Parent/Guardian Signature (for those under age 18): A S P B R H UMMC A . . ,VA