Petworks Paws For A Cause Run/Walkathon


Domtar Park, 1414 Riverport Rd, Kingsport, Kingsport, TN

11/3/2019


1:30 PM - Kid's 1 Mile Fun Run, 2:00 PM - 5K Run and 1 Mile Run/Walk (both races will run concurrently). The courses will be on an oval trail circling Domtar Park. Proceeds benefit the new Kingsport Petworks. Bring your furry friends!

Pre-registration:
(ends 11/2/2019)
$25 - 5K and 1 Mile Walk (both timed)
$20 - Kid's Mile (not timed)
| Regular
| Registration:
$35 - 5K and 1 Mile Walk (both timed)
$30 - Kid's Mile (not timed)
Make checks payable to: Petworks
Mail this form to: Petworks, 2141 Idle Hour Rd., Kingsport, TN 37660
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Tim Berringer, timberrigan@gmail.com
5K Run/Walk
Male & Female Awards:

Top Overall

Age Groups (top 3)
14 under, 15-19, 20-29, 30-39, 40-49, 50-59, 60 over
1 Mile Walk (Timed)
Male & Female Awards:

Overall (top 3)


Top 3 overall male and female

Petworks Paws For A Cause Run/Walkathon

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 Run/Walk | 1 Mile Walk (Timed)

*** 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.

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


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