Restore Your Sole 5K Run/Walk (Benefiting Haven of Rest Rescue Mission)


Virginia Creeper Trail
Green Springs Road
Abingdon, VA, Abingdon, VA

4/20/2019


8 am Registration
9 am 5K Run/Walk

Pre-registration:
(ends 5/13/2019)
$25 Early Registration Through May 6
Free for children under 12
| Regular
| Registration:
$30 After May 6
Free for children under 12
Make checks payable to: Haven of Rest Rescue Mission
Mail this form to: Restore Your Sole 5K
Haven of Rest Rescue Mission
624 Anderson Street
Bristol, TN 37620
Headphones are NOT permitted on the course | Strollers are permitted on the course
For more info contact
Jenny Rodefer / jrodefer@havenofrestbristol.org / 770-722-0393
Restore Your Sole 5K Run/Walk
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
Nineteen and under, 20-29, 30-39, 40-49, 50-59, 60-69, 70 and over

Restore Your Sole 5K Run/Walk (Benefiting Haven of Rest Rescue Mission)

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. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

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


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