Wise Primary Halloween Costume 5k race/1 mile fun walk


UVa-Wise, David J. Prior Convocation Center, Wise, VA

10/27/2018


9am-5k, 9:05am-1 mile fun walk, 9:15am-100 yard dash (3years-5 years)

Pre-registration:
(ends 10/15/2018)
T-shirts guaranteed to those who register by October 15, 2018 | Regular
| Registration:
5k-$15.00 Pre-k-12th grade, $20.00 adults
1 mile fun run/walk-$10.00 Pre-K-12th grade, $15.00 adults
100 yard dash (3 years-5 years) $10.00
Make checks payable to: Wise Primary School
Mail this form to: Wise Primary School, 323 Railroad Avenue, SE, Wise, VA 24293
Top 3 male/female, medals awarded for top 3 male & females in the following categories 10-19, 20-29, 30-39, 40-49, 50-59, 60-69 and masters 70
Best costume adult male/female, best costume kid adult male/female
100 yard dash winners male/female
Headphones are permitted on the course | Strollers are NOT permitted on the course
For more info contact
Karen Mullins at kmullins@wisek12.org
Wise Primary Halloween Costume 5k race
Male & Female Awards:

Overall (top 3)


...10,11-19,20-28,29-37,38-46,47-55,56-64,65-73,70...

Wise Primary Halloween Costume 5k race/1 mile fun 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: YS, YM, YL, 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.

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


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