2018 Family Fun Water Gun Run (& Walk)!


Saltville Medical Center , Saltville, VA

8/18/2018


Registration | 8:00am
Race | 9:00am

Pre-registration:
(ends 08/03/2018)
We will send you a registration form by email. Once filled out, send form to events@svchs.com. To receive the pre-registration discount, we must receive your form before August 3, 2018. Only people who pre-register will be guaranteed an event t-shirt. Reg | Regular
| Registration:
Regular Registration – $25

*Kids 10 & under are FREE! (This course will have some road crossings. Please make sure children run/walk with an adult. Volunteers will be placed at these points to assist.)
Make checks payable to: SVCHS
Mail this form to: 308 West Main Street
Saltville, VA 24370
Southwest Virginia Community Health Systems is hosting a 5K Family Fun Water Gun Run (& Walk) on Saturday, August 18, 2018 beginning at 9:00am at Saltville Medical Center. In honor of National Health Center Week, this event will help promote this year’s
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Kaylan Bales, kbales@svchs.com, 276-496-4492
2018 Family Fun Water Gun Run (& Walk)!
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2018 Family Fun Water Gun Run (& Walk)!

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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