3rd Annual Glo' Worm 5K Run/Walk


1089 Cedar Valley Drive
Cedar Bluff, VA 24609, Cedar Bluff, VA

9/26/2015


Experience the craziness of running through strobe lights and black lights while sporting your favorite storybook/movie character costume, glowing and wearing your swag. Participant perks: glo' t-shirt, glow in the dark bracelet/necklace.
Mile Glo'Run (12 & under) - 7:00 p.m.
Glo'Run 5K - 7:30 p.m.
Registration opens at 6:00 p.m. in the gymnasium.
Glo' & Costume Contest will be held in the cafeteria at 6:45 p.m. Trophies to be awarded during the 5K awards ceremony. There will be a Kid's Movie Time following the kids run in the cafeteria so parents can run the 5K.

Pre-registration:
(ends September 11, 2015)
$15 for Students 12 & under
$25 for Adults
| Regular
| Registration:
$20 for Students 12 & under
$30 for Adults
Make checks payable to: Cedar Bluff Elementary
Mail this form to: 1089 Cedar Valley Drive
Cedar Bluff, VA 24609
Experience the craziness of running through strobe lights and black lights while sporting your favorite storybook/movie character costume, glowing and wearing your swag. Participant perks: glow in the dark shirts, glow in the dark bracelet/necklace, free
Headphones are NOT permitted on the course | Strollers are permitted on the course
For more info contact
Charity McDaniel (276) 963-5765
Glo' Worm 5K Run/Walk
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
6 & under, 7-8, 9-10, 11-12, 13-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60+
Mile Glo'Run
Male & Female Awards:




Fun Run! Race is open to students 12 & under. No Fee! Runners may purchase a t-shirt for $10.00 Race starts at 7:00 p.m. After race students may report to the cafeteria for

3rd Annual Glo' Worm 5K Run/Walk

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: Glo' Worm 5K Run/Walk | Mile Glo'Run

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

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. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

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


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