Scorpion Swat 5K Run/Walk


Sullivan County Sheriff's Office
140 Blountville Bypass, ,

9/5/2021


6:00 pm. Please join us for fun and fellowship as we raise money to purchase much-needed equipment and safety gear for the SCSO Special Weapons and Tactics (SWAT) team. Participants in the 5K will compete for the top female and male awards in each age category as well as the top overall female and male finisher. This event is Family and Pet friendly. (Dog owners are responsible for
clean up and proof of vaccinations).

Pre-registration:
(ends 8/27/21)
$30 | Regular
| Registration:
$35
Make checks payable to: Friends of the SCSO
Mail this form to: Sullivan County Sheriff’s Office
ATTN: Aaron Hagy
P.O. Box 589
Blountville, TN 37617
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Aaron Hagy, ahagy@scsotn.com
Scorpion Swat 5K Run/Walk
Male & Female Awards:

Top Overall

Age Groups (top 3)
10under, 11-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 over

Scorpion Swat 5K Run/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 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.

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


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