2nd Annual Heart For Haiti/Ragged Edge Ministries 5K and Hotdog Lunch


Sugar Hollow Park, Bristol , VA

8/26/2017


10am at the Sugar Hollow Park

| Regular
| Registration:
25$
Make checks payable to: Ragged Edge Ministries
Mail this form to: Ragged Edge Ministries
332 wonderland dr Kingsport to 37660
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Normamullins178@yahoo.com
Paul.maggard@gressengineering.com
2nd Annual Heart For Haiti/Ragged Edge Ministries 5K and Hotdog Lunch
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
1-19, 20-35, 36-50, 51+

2nd Annual Heart For Haiti/Ragged Edge Ministries 5K and Hotdog Lunch

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: 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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