Stoney Creek Bunny Hop 5K


Location TBA, Elizabethton, TN

4/20/2019


Stay tuned for more information on this new event to benefit the Stoney Creek Volunteer Fire Department.

Pre-registration:
(ends 04/18/2019)
Fees TBA | Regular
| Registration:
Fees TBA
Make checks payable to: Stoney Creek Volunteery Fire Department
Mail this form to: Stoney Creek Volunteery Fire Department
200 Bill Lewis Rd
Elizabethton,TN, 37643
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Matt Williams, 423-440-9069
scvfdst1@gmail.com
5K Run/Walk
Male & Female Awards:

Top Overall
Top Masters

Age Groups (top 3)
Awards TBA

Stoney Creek Bunny Hop 5K

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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