Fit Farmer 5K / Kids Obstacle Course


Start and Finish Line at Norton Friends and Farmers Market Building, 815 Park Avenue SW, Norton, VA

5/13/2017


8 a.m. Registration opens
9 a.m. 5K Run
9:30 a.m. Kids Obstacle Course

All proceeds go to benefit the Norton Friends and Farmers Market "Senior Supplement Program." This program matches benefits to low­ income seniors, allowing them to purchase fresh, locally grown fruits & vegetables at the farmers market.

Pre-registration:
(ends 4/28/2017)
$15­ 5K Run/Walk
$12­ Kids Obstacle Course
| Regular
| Registration:
$20­ 5K Run/Walk
$15­ Kids Obstacle Course
Make checks payable to: Norton Friends and Farmers Market (NFFM) Memo: "Senior Nutritional Supplement"
Mail this form to: City of Norton, Attn: Melanie Fulks, P.O. Box 618 Norton, VA 24273 OR drop off form with payment at City of Norton Municipal Building or Norton Community Center
Only preregistered runners are guaranteed a shirt. Sizes and quantities will be limited on race day registration.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Michele Knox (michelek@nortonva.org, 276/679-0754)/Katie Dunn (katied@nortonva.org, 276/679-1160)
Fit Farmer 5K
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters


No age group awards. Everyone who completes the race receives a finisher award.
Kids Obstacle Course
Male & Female Awards:




Obstacle course is not timed. All participants receive prizes.

Fit Farmer 5K / Kids Obstacle Course

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: Fit Farmer 5K | Kids Obstacle Course

*** 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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