The Boys & Girls Club of Palacios is holding its 15th Annual Cinco de Mayo Celebration and Fundraiser which includes a Colorful 5K by the Bay run/walk. The event registration form collects contact information from participants including name, address, age, t-shirt size, and team name if applicable. Registration fees vary depending on the month and if participating as an individual or as part of a team. Participants or their parents must sign a waiver releasing the Boys & Girls Club from any claims of injury from the event.

1. Boys & Girls
Club
“Serving our Youth”
Boys & Girls Club of Palacios 2014
th
15 Annual Cinco de Mayo Celebration / Fundraiser
United Way
Registration Form
Name: ___________________________________
Address: ___________________________________
City: ____________________ State: ______ Zip: ________
Phone # : ___________________
Email Address:________________________________________
Sex: ___ Male ____Female
Age as of 5-3-14 _____________
Emergency Contact Name: _____________________________
T-shirt size
Phone # :_________________________________
Please check box below
T-shirt and bag of color included in registration
Solo Runner/Walker
□ $30 February
□ $35 March
□ $40 April
□ $45 May
Adult - 18 or older when part of a team of 4 or more
□ $25 per person February
□ $30 per person March
□ $35 per person April
□ $40 per person May
Youth – Under 18 when part of a team of 4 or more
□ $20 per person February
□ $25 per person March
□ $30 per person April
□ $35 per person May
___ YS
___ YM
___ YLG
___ AS
___ AM
___ ALG
___ AXL
___ 2XL
___ 3XL
___ 4XL
******* 4 Blast Zones *******
TEAM NAME: _______________________________________________
Ages 5 and under FREE
Go to www.palacioskids.org to register online or for information
about the Colorful 5K by the Bay and packet pick up locations.
Entry form: Please print and mail to: Boys & Girls Club of Palacios, PO Box 843, Palacios, TX 77465
Make checks payable to: Boys & Girls Club of Palacios
For more information, contact the Boys & Girls Club @ (361) 972-2642 or email bgclub@palaciosisd.org
This waiver of claim statement must be signed and submitted with registration in consideration of acceptance of this entry. I waive and
release any and all claims I may have against the Boys & Girls Club of Palacios or its volunteers or firm or organization for any and all
injury, illness, or loss which may directly or indirectly result from my participation in this event. This waiver shall be binding on my heirs,
legatees, administrators and assignees. This entry is invalid unless signed by entrant. If entrant is less than 18 years of age, a parent
or guardian must sign this form.
______________________________________________
Entrant’s/Parent’s signature
Date
______________________________________
Print Parent Name if entrant is under 18