2026 Blender Dash Scholarship Application- English

BLENDER DASH
Tualatin Community Park
8515 SW Tualatin Rd, Tualatin, OR
Saturday, June 6, 2026
9am-1pm

The City of Tualatin’s Parks & Recreation Department will be holding the Blender Dash on Saturday June 6^th at Tualatin Community Park. The Blender Dash is a fun run that includes elements from everyone’s favorite themed runs including color, foam, mud, obstacles, and even zombies!

The City of Tualatin has scholarships available for up to 5 children from each from each school in the Tigard-Tualatin School District for the Blender Dash.

Please complete the form below for each child that would like to participate. The form must be signed by a parent or guardian.

All forms must be completed by May 29.

For more information contact Heidi Marx at hmarx@tualatin.gov

Blender Dash Scholarship Information 2026

Blender Dash Scholarship Information 2026 Printable Blender Dash Scholarship Form

Sponsor Information

Sponsor Company Name

Participating Child Information

Child Name(Required)

First Last

School(Required)

Date of Birth(Required)

Current Grade(Required)

Select your race start time(Required)

10:00am Purple Group

10:45am Green Group

Parent/Guardian Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Information will be sent via email unless otherwise requested. Please be sure to submit a working email address.

Phone(Required)

Emergency Contact Information

Name(Required)

First Last

Phone(Required)

Consent(Required)

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Waiver of Liability, Photo/Video Release, Medical Release, and Parent Permission
Please read this form carefully and be aware that by your participation in this program/activity, you are expressly assuming risk and legal liability and waiving and releasing all claims for injuries.

Waiver of Liability
I recognize and acknowledge that there are certain risks of physical injury and property by participating in this program. I agree to assume the full risk of any injuries, including loss of life, personal injuries, property damages, and expenses, which I may sustain as a result of participating in any and all activities connected with or associated with the City of Tualatin program. I also hereby waive, release, indemnify, hold harmless, defend, covenant not to sue, acquit, and forever discharge, the City of Tualatin and all officials, employees, officers, and agents of the City of Tualatin, from and against any and all rights of action, claims, demands, liabilities, injury, losses, or damages of any kind, arising in whole or in part out of my participation in the City of Tualatin Program. This includes, without limitation, claims based upon loss of life, personal injuries, or property damages, sustained by me or caused by me. I agree to assume all risks associated with participation in the program and acknowledge and agree that the City of Tualatin assumes no liability.

Photo/Video Release
I hereby grant to City of Tualatin and its officers, employees, and agents, permission, with no claim of payment, to record my image and comments, regardless of the media used to capture my image and comments, together with the right to use, publish, copyright, and reproduce in whole or in part any such image and/or comment for use by the City for business purposes, including, but not limited to promotional materials, public relations, development, or any other legitimate business purpose of the City. I hereby waive any and all rights that I may have to inspect or approve any such image and/or comments or completed products which incorporate all or part of any such image and/or comments. I hereby release and hold harmless the City from any and all liability arising out of or in any way related to the use of such images and comments, including but not limited to any liability arising by virtue of any blurring, distortion, alteration, illusion, editing, or use in composite form, whether intentional or otherwise, that may occur in the making or processing of the finished product.

Medical Release
Due to the strenuous nature of some activities, the participant, or if the participant is a child, the child’s parent or guardian, is encouraged to consult a physician concerning the participant’s fitness to participate in the program. In case of emergency, accident, or illness, I give my permission and consent for the listed participant to be treated by an emergency medical technician and/or medical professional and admitted to a hospital, whether medically necessary or as a precaution. I authorize the City to transport the named participant to the nearest hospital in case of injury or suspected injury while the participant is involved in a city program or activity. I agree to be the party responsible for all medical and hospital expenses occurred on behalf of the above participant.

Parent Permission
I (we), parent(s) of, or legal guardian(s) for, the above participant, hereby consent to participation in this City of Tualatin Program. On behalf of the participant listed, I accept the waiver of liability, photo/video release, and medical release provisions of this registration form.

Signature of Parent/Guardian(Required)