Registration Form – 5k Virtual Fun Run/Walk/Tread

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Proceeds benefit the Xenia Community Schools Foundation Classroom Grants Program

This is now a virtual event! Registrants will set a goal of completing one, two or three 5k walk/run/treads during October. Upon reporting back completion of their commitment (on their own or with friends at a time and place of their choice), registrants will be awarded a participation medal in bronze, silver or gold based on the goal they achieved.

All registrants will receive an event shirt to wear during the entire month of October in support of the run/walk/tread. Those who simply want to support the Healthy Halloween Hustle, can just register and receive a shirt.

Want to mail your order in?

Click here to download the form


Register Online Below

Event Date: October 1, 2018 – October 31, 2018
Registration Deadline Date: September 14, 2018
Time: Choose your own time and place during the month of October

Registrants will receive instructions about shirt delivery/pick-up and medal distribution in late September. A limited number of shirts will be available for late registrations.

Your name (required)

School (optional)

Address (required)

Phone (required)

Email (required)

Adult/Student:

Adult & Youth Shirt Sizes

Adult Shirt Size

Please note:

  • Registration Deadline to be guaranteed a shirt is September 14, 2018. A limited number of shirts will be available for onsite registrants.
  • There is a .76 fee for adults and a .61 fee for students paying via PayPal; this fee will not be charged for paying via mail. Mail in/drop off fees are $15.00 for adults and $10.00 for students.

Personal Goal:


Release

Release for (required):

Release: In consideration of the acceptance of my entry, I, for myself, my executors, administrators, and assignees, do hereby release and discharge the Xenia Community Schools Foundation and its/their officers, directors, trustees, employees, agents, and all other sponsors and individuals assisting in the presentation of the race for all claims of damages, demands and actions whatsoever in any manner arising or growing out of my participation in said athletic event. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit and sufficiently trained to participate in this event.

Participant or Legal Parent or Guardian (if participant is a minor):

Date:

  • Payment Option 1: PayPal can be used for online registration. PayPal fees are the responsibility of the registrant. Payment in full must be made at time of registration.
  • Payment Option 2: Place a copy of the registration form, a check or Money Order or cash in a sealed envelope. Please mail the registration form and payment to the Xenia Community Schools Foundation, c/o The Xenia Area Chamber of Commerce, 334 W. Market St., Xenia, OH 45385. Registrations, with payment, can also be dropped off at the Chamber office or left in the office at each Xenia Community school building.
  • You can download the form here.