Scarecrow Skedaddle


ETSU/Mountain States Health Alliance Athletic Center
1081 John Robert Bell Dr, Johnson City, Tennessee 37614, Johnson City, TN

10/28/2017


This 2-Mile Run is brought to you by Niswonger Children's Hospital. A Modified Race (200-meter) will begin at 9:45 AM with the 2-Mile Run starting at 10 AM. This is an USATF-Certified 2-mile course (good for TN state age records) on the ETSU Campus, starting and finishing in front of the Mountain States Athletic Center (Mini Dome). The event is open to all ages. The entry fee is only $10. Race participants that register by Oct. 16th will receive a t-shirt and finishers medal. After the race, the community is welcome to join us inside the Dome for Family Activities Day.

*Modified Race is for kids who may need assistance with wheelchairs and/or walkers.

Pre-registration:
(ends 10/23/2017)
Only $10!!
*Guaranteed t-shirt & size deadline Oct. 16, 2017
| Regular
| Registration:
Only $10!!
*Guaranteed t-shirt & size deadline Oct. 16, 2017
Make checks payable to: Mountain States Foundation
Mail this form to: Scarecrow Skedaddle
Attn: The Goose Chase
3101 Browns Mill Road, Ste. 6-182
Johnson City, TN 37604
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Event Management by The Goose Chase
423-946-0519 or info@thegoosechase.org
Scarecrow Skedaddle
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters

Age Groups (top 3)
19 & Under, 20-29, 30-39, 40-49, 50-59, 60-69, 70 & Older
Modified Fun Run/Walk
Male & Female Awards:




All awards will be announced at the Family Activities Day festivities.

Scarecrow Skedaddle

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: Scarecrow Skedaddle | Modified Fun Run/Walk

*** 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.

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


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org