Shop With A Cop Superhero 5k & Family Fun Run


ETSU Campus, Johnson City, TN

11/10/2018


Come join us Saturday, November 10th at 9 a.m. on the beautiful campus of ETSU for a 5k run and a 1 mile interactive superhero fun run presented by the Johnson City Police Department! All proceeds go to the local Shop With A Cop program.

Pre-registration:
(ends 11/10/2018)
$25
$15 Kids
| Regular
| Registration:
Late Registration - Nov 9th
$30
$20 kids
Make checks payable to: City of Johnson City - Shop With A Cop
Mail this form to: 3101 Browns Mill Rd
Suite 6-182
Johnson City TN 37604
Headphones are permitted on the course | Strollers are NOT permitted on the course
For more info contact
Karen or Ashley
info@thegoosechase.org
4239460519
5k timed
Male & Female Awards:

Overall (top 3)
Masters (top 3)
GrandMasters (top 3)

Age Groups (top 3)
9 & under, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 & Older
Family Fun Run
Male & Female Awards:




No Awards

Shop With A Cop Superhero 5k & Family 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 EVENT: 5k timed | Family Fun Run

*** CIRCLE SHIRT SIZE: YM, 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)


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org