Black Knight Challenge 5K run/walk


Chuckey Doak High School
365 Ripley Island Road
Afton, TN 37616, Greeneville, TN

11/4/2017


9 a.m. — 5K Fundraiser
Kids run after the main event

Pre-registration:
(ends 10/28/2017)
$15 — Adults, $10 — Students until 10/28/2017 | Regular
| Registration:
$20 — Adults, $10 — Students after 10/28/2017
Make checks payable to: Chuckey Doak High School
Mail this form to: ATTN: Black Knight Challenge 5K
365 Ripley Island Road
Afton, TN 37616
All registration fees from this 5K fundraiser will be donated to the Chuckey Doak High School Cross Country and Track teams.
Headphones are permitted on the course | Strollers are NOT permitted on the course
For more info contact
Funds generated by this 5K fundraiser will benefit the Chuckey-Doak High School cross country/track team.
Awards by age group and snacks after the race.

Noah Naseri
365 Ripley Island Road
Afton, TN 37616
423-552-2725
Black Knight Challenge 5K
Male & Female Awards:

Overall (top 3)


...19,20-29,30-39,40-49,50-59,60-69,70...

Black Knight Challenge 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 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. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE.

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


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