Piney Flats Days 5K


Mary Hughes Elementary School
240 N. Austin Springs Rd.
Piney Flats, TN, Piney Flats, TN

8/5/2022


7:00 pm. This 5k will kick off this year's "Piney Flats Days"-a large celebration the Ruritan Club sponsors in our community each August. Run through the community of Piney Flats starting and ending at Mary Hughes Elementary School while going past some historical areas in Piney.

Pre-registration:
(ends 8/4/22)
$25 | Regular
| Registration:
$30
Make checks payable to: Piney Flats Ruritan Club
Mail this form to: Piney Flats Ruritan Club c/o Aimee Sexton
916 Allison Rd
Piney Flats TN 37686
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Aimee Sexton amking74@icloud.com 423-433-9803
Piney Flats Days 5K
Male & Female Awards:

Overall (top 3)

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

Piney Flats Days 5K

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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