Power of Health Expo & Power of Play 5K Run/Walk


Bristol Regional Medical Center Campus
1 Medical Park Boulevard, Bristol, TN

4/29/2017


9:00 am Power Of Play 5K
8am-12pm Power Of Health Expo
Join us for the Power of Health Expo and Power of Play 5K, a partnership of Bristol Regional Medical Center, the Wellmont CVA Heart Institute, Bristol Tennessee City Schools and Bristol Virginia Public Schools. By teaming up, we can focus on the benefits of good health and fitness at all ages. All registered participants, 18 and older, will receive a free HeartSHAPE coupon (early detection screening for heart disease). The expo will feature health and wellness vendors and cardiovascular screenings for those who pre-register.

Proceeds from the Power of Play 5K will benefit physical education and physical activity in Bristol TN City Schools and Bristol VA Public Schools.
Early packet pick-up: Friday, April 28, 4-6 p.m. Bristol TN City Schools Administration Bldg. 615 Martin Luther King Jr., Blvd.

Pre-registration:
(ends 4/27/17)
$20 5K Run Timed
$15 5K Walk Untimed
$10 Students (Elementary, Middle, High School)
***Only pre-registered participants are guaranteed a race shirt.
| Regular
| Registration:
$25 5K Run Timed
$20 5K Walk Untimed
$15 Students (Elementary, Middle, High School)
Make checks payable to: Wellmont CVA Heart Institute
Mail this form to: Wellmont CVA Heart Institute – Power of Play 5K
130 W. Ravine Road
Kingsport, TN 37660
Attn: Lindsay Hammitt/Administration
If you are running/walking for a Bristol TN/VA school, enter that school name on the Team Name line.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Lindsay Hammitt, lindsay.hammitt@wellmont.org
Rebecca Craddock, craddockR@btcs.org
5K Run
Male & Female Awards:

Top Overall

Age Groups (top 3)
10 under, 11-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70 Over
5K Walk - Untimed
Male & Female Awards:



Age Groups (top 3)
Non-Competitive

Power of Health Expo & Power of Play 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)_________________________________________

TEAM NAME____________________________

*** CIRCLE EVENT: 5K Run | 5K Walk - Untimed

*** CIRCLE SHIRT SIZE: XS, 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.

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


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