9th Annual Hummelstown Hunger Run Registration Form
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First Name __________________________________ Last Name _________________________________________
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Address ________________________________________________________________________________________
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City _____________________________________________________________________ State _________________
Email __________________________________________________________ Phone # ________________________
(please circle)
Age as of 5/11/24 ________________________ Gender M F
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Entry type
By 5/4 5/4 – 5/11
5K Run $30.00 $35.00
5M Run $30.00 $35.00
5K Run – Student rate $20.00 $20.00
5M Run – Student rate $20.00 $20.00
5K Walk - Student rate $20.00 $20.00
5K Walk $20.00 $25.00
Children 10 & under are free with participating adult**If your child is running and wants a chipped bib –
please register them under the Student Rate
**A bag lunch will be provided for each registrant and volunteer.
Bag lunches or race t-shirts for children 10 & under can be purchased here.
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EXTRA bagged lunch/es - how many ______ x $8.00 = _______________
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T-Shirt (50/50 blend ) â–¡ or Tech shirt (Drifit) â–¡
Adult S â–¡ M â–¡ L â–¡ XL â–¡ (included with entry free)
XXL â–¡ $5.00 XXXL â–¡ $5.00
Youth XS â–¡ (t-shirt only) S â–¡ M â–¡ L â–¡ XL â–¡
No T-shirt (I would rather donate the cost to the Hummelstown Food Pantry) â–¡
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Extra t-shirt - how many ______ x $10.00 = ________________ Type and size __________________________________
T-shirts guaranteed if registered by 4/23.
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All registrations must include signed waiver.
WAIVER: I understand that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and forever discharge the Borough of Hummelstown, event organizers, sponsors, promoters, and each of their agents, representatives, successors and assigns, and all other persons associated with the event, for all my liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise. I understand that the entry fee is non-refundable and non-transferable. I hereby grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, website images, recordings or any other record of this event.
SIGNATURE __________________________________________________________ DATE __________________
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Mail form and check (payable to: Hummelstown Food Pantry) to Hummelstown Hunger Run c/o Jill Osevala, 117 Stone Mill Road, Hummelstown, PA 17036