5 mile road race to benefit the Friends of Rocky Fork State Park All participants receive a mug instead of age group awards |
| Pre-registration: (ends 09/22/23) |
$30 with a t-shirt, $15 no t-shirt, $14 for SFTC without a t-shirt | | Regular | Registration: |
$25 on race day no t-shirt There will NOT be extra t-shirts, so if you want one preregister. | |
| Make checks payable to: Friends of Rocky Fork State Park | ||||
| Mail this form to: The Bat C/o Lisa Hazlett 1100 Bellingham Drive Kingsport, TN 37660 | ||||
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Lisa Hazlett Lhazlett@k12k.com | The Bat 5 Miler Male & Female Awards: Top Overall Top Masters Top GrandMasters Top Sen.GrMasters ...10,11-15,16-20,21-25,26-30,31-35,36-40,41-45,46-50,51-55,56-60,61-65,66-70,71-75,76-80,80... |
| 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, 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. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE. |
|
SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |