All early registrants will receive a nice Runnin for a Youngun 5k t-shirt and medals will be awarded to over-all, masters and age group winners. Late registrations will receive T-shirts as they are available.
The Boys & Girls Club of the Mountain Empire has sites in Bluff City, Bristol Tennessee and Bristol Virginia, Abingdon and on the campus of UVA-Wise. Last year we served over 900 kids at these locations. The money raised at this event will enable us to continue to provide a safe place for youth in our area to go after school and in the summer. We depend on the generous support of our community to be able to fund these programs for the kids who need us most.
Come on out and have fun Runnin for a Youngun!
|$25|| | Regular
|Make checks payable to: Boys & Girls Club of The Mountain Empire|
|Mail this form to: Boys & Girls Club of The Mountain Empire|
P.O. Box 1074
Bristol, VA 24203
|Headphones are permitted on the course | Strollers are permitted on the course|
|For more info contact|
Elaine Rock, firstname.lastname@example.org
Male & Female Awards:
Age Groups (top 3)
9 under, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70 over
|LAST NAME__________________________________ FIRST NAME_________________________ M.I._______|
SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________
CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________
RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________
*** CIRCLE SHIRT SIZE: YS, YM, 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)