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
Early Packet Pick-up: Friday, April 21st Location to be announced
Chocolate milk, water, bananas and granola bars will be waiting for each participant as they finish!
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 NOT permitted on the course | Strollers are NOT 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. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

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


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