6th Annual  

Patriot Color Splash 5k

Fun Run/Walk

Please complete one registration form for each participant.

When:  May 11, 2019

Where:  Hillsville Elementary School – Physical Address: 2605 Floyd Pike, Hillsville, VA 24343

Time:  7:30-8:30 packet pick-up, 8:30 race instructions, 9:00 race begins, 10:30 Color Palooza

Description:  The Patriot Color Splash 5K will be untimed fun run/walk event.  Enjoy the scenic views around Hillsville Elementary Patriot’s Trail, while being “splashed” with different colors.  The “color splash” is dyed cornstarch that is 100% non-toxic and completely biodegradable.  Eye protection is suggested.  All proceeds will go towards Hillsville Elementary School’s playground fund.  

Registration: Early Bird Special - $15 for Students (age 18 & under) or $20 for an Adult (before April 19th)

                  After April 19th - $20 for a Student or $25 for an Adult

                       *to be guaranteed a t-shirt, make sure you are registered before April 19th 2019

First Name ____________________________________________            Last Name ____________________________

Street Address _________________________________________________________________________

City _____________________________________                  State ________            Zip _________________________

Date of Birth ____/____/_____             Age_____                     Male / Female  (circle one)

E-mail ________________________________________       Phone Number __________________________

Shirt Size (circle one)        YOUTH                 S        M        L

                        ADULT                S        M        L        XL        XXL

WAIVER:  I understand that running/walking a road and trail combined course is potentially dangerous activity.  I should not enter and run/walk unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk.  I assume all risks associated with running or walking in this event, including but not limited to fall, contact with other participants, the effects of the weather, traffic and the condition of the roads and trails.  Having read this waiver and knowing these facts and in consideration of your accepting my entry, I myself and anyone entitled to act on my behalf, waive and release Hillsville Elementary, HES PTSO, race officials, Volunteers, and all sponsors from all claims and liabilities of any kind arising out of my participation in this event.  I give race officials permission to photograph and/or videotape me during the event, and use my pictures and/or video recording in future publications.  I have read the above release and understand that it presents a risk of physical injury, knowing this I am entering this event at my own risk.  I understand that this event will occur rain or shine, and that there will not be any refunds.

Entry Signature ________________________________________        Date _____________________

Parent’s Signature(required of entrants under 18)______________________________________        Date _____________________

Emergency Contact __________________________________                      Phone#____________________

Checks should be made payable to HES

Registrations may be turned in at Hillsville Elementary School or mailed to:

Hillsville Elementary School

Attn: Color Run

90 Patriot Lane

Hillsville, VA 24343

  • Eye Protection is Suggested
  • Bring a Towel
  • Please No Pets

Event Schedule:

Friday, May 10th 

4:00-5:30 Early Packet Pick-Up

Saturday, May 11th 

7:30-8:30 packet pick-up

8:30 Race instructions

9:00 Race begins

10:30 Color Palooza