Sullivan County Sheriff's Office Scorpion 5K Run and 2 Mile Walk


Sullivan County Sheriff's Office, Blountville, TN

8/25/2019


6pm - 5K
6:05pm 2 Mile Walk

Pre-registration:
(ends 8/9/2019)
$25 | Regular
| Registration:
$30
Make checks payable to: Friends of the Sullivan County Sheriff's Office
Mail this form to: ATTN: Aaron Hagy
Sullivan County Sheriff's Office
P.O. Box 589
Blountville, TN 37617
Only preregistered runners and walkers are guaranteed a shirt.
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Aaron Hagy
ahagy@scsotn.com
423-279-6050
Sullivan County Sheriff's Office Scorpion 5K
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...10,11-20,21-30,31-40,41-50,51-60,60...
Sullivan County Sheriff's Office 2 Mile Walk
Male & Female Awards:

Top Overall

Top Age Groups
...19,20-29,30-39,40-49,50-59,60...

Sullivan County Sheriff's Office Scorpion 5K Run and 2 Mile 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 EVENT: Sullivan County Sheriff's Office Scorpion 5K | Sullivan County Sheriff's Office 2 Mile Walk

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

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


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