Save the Animals


Lebanon Primary School campus - Lebanon, VA, Lebanon, VA

5/20/2017


All money raised goes to local animal shelter.
Packet pickup starts at 8 am.
Race day sign up from 8 am - 9 am
Race begins at 9:30 am on Lebanon Primary School campus, 919 Main Street, Lebanon, VA.
Register early for Save the Animals T-shirt. Run or walk with or without your dog.

Pre-registration:
(ends 5/12/2017)
$25 if received by 5/12/17 (Please add $5 per dog) | Regular
| Registration:
$30 if registering after 5/12/17 (Please add $5 per dog)
Make checks payable to: Crystal Ball
Mail this form to: 155 Granville Meadows Dr
Lebanon, VA 24266
5K run/walk will begin at 9:30 am. Participants may choose to run/walk
with or without a pet. Pet owners are asked to clean up after their
pets. Water will be provided on the course for the animals as well as
the registration area.
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Crystal Ball, cball8108@gmail.com, 276-791-7127
Save the Animals
Male & Female Awards:

Overall (top 3)
Masters (top 3)

Age Groups (top 3)
...1-12, 13-19, 20-29, 30-39, 40-49, 50-59, 60+

Save the Animals

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)


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