The Arc & The Field of Doom OCR


Fender's Farm and Corn Maze
254 Highway 107, Jonesborough, TN

5/11/2019


Join us for this inaugural obstacle course race at Fenders Farm to raise funds and awareness about The Arc of Washington County! This will be an 'Indiana Jones' themed obstacle course race with some of your favorite items from the movie trilogy. This OCR is definitely a family favorite.

Pre-registration:
(ends 06/01/18)
Individuals & Team
$35 through Jan. 31
$45 Feb. 1 - May 10

Kids
$15 through Jan 31
$20 Feb. 1 - May 10
| Regular
| Registration:
Individuals & Team
$55 May 11

Kids
$25 May 11
Make checks payable to: The Arc of Washington County
Mail this form to: The Goose Chase
3101 Browns Mill Road, Ste. 6-182
Johnson City, TN 37604
Guaranteed shirt cut off May 1st
Packet Pickup May 11th from 7:30-9:30 a.m. at Fender's Farm

Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
The Goose Chase
423-946-0519
info@thegoosechase.org
Individuals | Team
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters

Age Groups (top 3)
10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 and over.
Kids
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
10 & under

The Arc & The Field of Doom OCR

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)_________________________________________

TEAM NAME____________________________

*** CIRCLE EVENT: Individuals | Team | Kids

*** CIRCLE SHIRT SIZE: 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