Registration Form – 5k Fun Run/Walk

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Want to mail your order in?

Click here to download the form


Register Online Below

Date: October 21, 2017
Location: Shawnee Park, Xenia, Ohio
Time: 9:00 am
Day of Event: On-site Registration and Packet Pickup – 8:00am
(Registration and packet pickup will be at Central Middle School in the event of inclement weather)

Your name (required)

School (optional)

Address (required)

Phone (required)

Email (required)

Adult/Student/Child Under 5:

Adult & Youth Shirt Sizes

Adult Shirt Size

Children under 5 can participate for free in a fun run and receive a pumpkin and a participation ribbon but no shirt. For a child under 5 to receive a shirt, please register the child as a student at a cost of $10.59.)

Please note:

  • Registration Deadline to be guaranteed a shirt is October 6, 2017. 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.

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.