Russell County Search & Rescue Mud & Obstacle Relay


Russell County Fairgrounds
237 Donnie Dean Drive
Castlewood, VA
, Castlewood, VA

4/22/2017


Join us for this fun relay, with lots of mud and obstacles! Course will be a total of 4 miles, with a 1 mile loop to be completed as a relay by each team member. Prize for 1st team to complete the course! Relay starts at 10:00 AM
Register by April 14 to guarantee your race t-shirt!

Pre-registration:
(ends 4/25/2016)
4 Person Relay Event - Team Members $30 each
| Regular
| Registration:
4 Person Relay Event - Team Members $40 each
Make checks payable to: Russell County Combined Search & Rescue
Mail this form to: 948 Twin Oak Circle
Lebanon, VA 24266
Awards for first place team and first place individual
Headphones are permitted on the course | Strollers are NOT permitted on the course
For more info contact
Kim Short
276-619-1817
ksshort03@gmail.com
Russell County Search and Rescue Mud & Obstacle Relay
Male & Female Awards:




...19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60...

Russell County Search & Rescue Mud & Obstacle Relay

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: 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.

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


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