Greene County Schools/Horace Mann Lace up for Literacy


Greene County Fairgrounds, Greene County Fairgrounds,

7/28/2018


6:30 Registration
5K start at 7:30

Pre-registration:
(ends 07/20/2018)
$20 pre-registration | Regular
| Registration:
$25 Day of Race
Make checks payable to: Greene LEAF Foundation
Mail this form to: Greene County Schools, 910 W. Summer St, Greeneville, TN 37743
All proceeds to benefit the Magic Book Bus project which provides a mobile library for students during the summer
Headphones are permitted on the course | Strollers are NOT permitted on the course
For more info contact
Kristi Wallin, kristi.wallin@gcstn.org, 423-639-4194
Chris Sharp, chris.sharp@gcstn.org, 423-235-5406
Greene County Schools/Horace Mann Lace up for LIteracy
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
1-14; 15-25; 26-35; 36-45; 46-55; 56-65; 66+

Greene County Schools/Horace Mann Lace up for Literacy

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: 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.

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


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