8.15 am - Kids Mile (KFOM) & Mile Walk USATF Cert# VA4022RT | 8:30am - 5K Run (USATF Cert# VA04019RT. The mile walk is open to all ages (both kids and adults). Participation medals are given to all Kids Milers. The races benefit The Lauren Elizabeth Cole Memorial Scholarship Fund at ETSU |
| Pre-registration: (ends 8/10/2012) |
5K: $13 Kids Mile: $10 $1 SFTC discount | | Regular | Registration: |
5K: $15 Kids Mile: $12 $1 SFTC discount | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: Washington County Recreation Department | ||||
| Mail this form to: Washington County Recreation Department, 205 Academy Drive, Abingdon, VA 24210 | ||||
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact (276) 525-1385 | Schoolhouse 5K Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Top Sen.GrMasters Age Groups (top 3) ...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70... | Kids Mile & Mile Walk Male & Female Awards: Particiipation medals are given to all Kids Milers. The Mile Walk is non-competitive. |
| 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)_________________________________________ |
*** CIRCLE EVENT: Schoolhouse 5K | Kids Mile & Mile Walk |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, |
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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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |