WCC Sprint for Scholarship 5K Run/Walk & Kids Fun Run


Wytheville Community College, Wytheville, VA

9/28/2018


6 p.m.

Pre-registration: $20 preregistration | Regular
| Registration:
$25 day of
Make checks payable to: WCC Educational Foundation
Mail this form to: 1000 E. Main Street
Wytheville, VA 24382
Only preregistered runners are guaranteed a race shirts
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Jill Ross
jross@wcc.vccs.edu
(276)223-4880
WCC Sprint for Scholarships 5K Run/Walk
Male & Female Awards:

Overall (top 3)


...19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60...

WCC Sprint for Scholarship 5K Run/Walk & Kids Fun Run

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,

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)


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