First and Last Name: ______________________________________________ (Circle one): Student $15 Adult $20
Adult Contact Phone #: ____________________________________________________________________________
T-Shirt Size (circle one): Adult S Adult M Adult L Adult XL (Adult XXL add $3) Youth S Youth M Youth L
* The race will not be timed. All finishers will receive finisher medals. First, second, and third place male and female winners will receive awards. Packet pick-up is from 8:00 – 8:45 a.m. The race will start at 9:00 a.m. in front of the elementary lunchroom. The course will be an out and back closed course.
ENTRY FEE
Pre-registration: $20 – Adult $15- Student (12>span class="qowt-font1-Calibri" qowt-format="{"udl":false}"> grade and under)
Deadline to pre-register and guarantee a t-shirt and finisher medal is Friday, May 13, 2022.
Make checks payable to Melbourne Elementary.
Return to the office or mail registration and payment to: Melbourne Elementary
ATTN: Color the Bearkatz
P.O. Box 250
Melbourne, AR 72556
Race Release: (must be signed by participant/parent or guardian)
I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event and in good physical condition. I know that this is a potentially hazardous activity, and I hereby assume full responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event. In consideration of acceptance of this entry, I waive and release all claims for myself and my heirs against the race organizers and any and all sponsors of this race from any liability or any loss, damage, or injury which I may incur as a result of my participation in this race. I further state that I have trained and I am in proper physical condition to participate in this race. This entry is not valid unless signed by the entrant. If the entrant is under 18 years of age, the parent or guardian must sign the entry form.
Signature: ______________________________________________ Date: ________________
Parent/Guardian Signature: ____________________________________________ Date: _________________
Entry form is not valid without a signature and will be returned. Parents must sign for children under 18. Must have one form per person.
For questions regarding the Beth Cooper Memorial Fund, please contact Lori Loggains or Steven Chaney. To make a donation, see any school employee. The deadline to sponsor our race and have your business’s name appear on our shirt is also Friday, May 13, 2022.