FRIENDS Buddy Run 5K & Family Walk with Special Needs Dash


ETSU - East Tennessee State University, Johnson City, TN

4/22/2017


Course location is at ETSU. Start and finish at the Culp Center
8:30-9:15am - Day of registration
9:30am- Special Needs Dash (All special needs participants will receive a medal)
10:00am- 5K Run/Walk
REGISTER BY APRIL 5TH TO GUARANTEE A SHIRT IN YOUR SIZE
Early Packet Pick-up: Friday, April 21st Fleet Feet Johnson City (302 Buffalo Street, Suite 100. Johnson City) 4-6pm
Chocolate milk, water, bananas and granola bars will be waiting for each participant as they finish!
Bojangles will be present to provide goodies to the race participants!
PIZZA WILL BE DELIVERED AT 10:45am for all participants and we will have a DJ - Plan on having some FUN!
Hosted by FRIENDS (Friends Reaching, Inspiring, Educating Neighbors about Down Syndrome)

Make checks payable to: FRIENDS
Mail this form to: PO Box 5677 Johnson City, TN. 37602
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Misty Adams
mistyadams2@gmail.com
865-898-7828
FRIENDS Buddy Run 5K & Family Walk & Special Needs Dash
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
...19,20-29,30-39,40-49,50-59,60...

FRIENDS Buddy Run 5K & Family Walk with Special Needs Dash

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: 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)


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