Breaks Park/Kiwanis Cross Country Run


, Breaks, VA

10/1/2022


10am...The race will cover approximately 3.1 miles in and around the center attractions of the Breaks Park. The run begins and ends at Shelter # 3 across from the water park. Route will travel through trail portions of the park and towards the cottage area and back. A pancake breakfast for all participates will be provided. Immediately, following the main race a middle school division for grades 5th, 6th, 7th and 8th will be held, this will be a 1.5 mile run. Trophies for the top three male and females will be provided.

Pre-registration:
(ends 9/26/2022)
$15 | Regular
| Registration:
$20
Make checks payable to: Grundy Kiwanis Club
Mail this form to: PO Box 724
Grundy, Va. 24614
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Jon Rife, jonrife@rifestv.net
Ricky Owens rickyowens@rifestv.net
Breaks Park
Male & Female Awards:

Top Overall
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60...

Breaks Park/Kiwanis Cross Country Run

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,

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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