Cougar Courage 3k


Sullivan Central High School
131 Shipley Ferry Road
Blountville, TN 37617, Blountville, TN

5/12/2012


9:00 a.m.

Pre-registration:
(ends 5/5/2012)
Adults: $15 (with T Shirt), $10 (without T Shirt)
Students: $10 (with T Shirt), $5 (without T Shirt)
| Regular
| Registration:
Adults: $18
Students: $15
Make checks payable to: Sullivan Central High School
Mail this form to: Cougar courage 3K
c/o Ruth Leonard
Sullivan Central High School
131 Shipley Ferry Road
Blountville, TN 37617
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Ruth Leonard
ruth.leonard@sullivank12.net
(423)354-1200
Cougar Courage 3K Run/Walk
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
...8, 9-11,12-14,11,12-14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70...

Cougar Courage 3k

LAST NAME__________________________________ FIRST NAME_________________________ M.I._______

SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________

ADDRESS___________________________________________________________________________

CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________

RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________

TEAM NAME____________________________

*** CIRCLE SHIRT SIZE: YM, YL, SM, MD, LG, XL,

IN CONSIDERATION FOR ACCEPTING MY ENTRY IN THIS RACE, I FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN SAID RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org