All net proceeds will go to Gentle Move Colon Foundation to benefit those in need of assistance with special supplies and colon coaching. Please join us as we run, walk, or stroll our way to a healthier colon! |
| Pre-registration: (ends 4/20/2023) |
$20 until March 1 $25 March 2 - April 20 | | Regular | Registration: |
$30 | |
| Make checks payable to: Gentle Move Colon Foundation | ||||
| Mail this form to: Gentle Move Colon Foundation PO Box 1163 Jonesborough, TN 37659 | ||||
| If you want boxers instead of a T-shirt please write "Boxers" on your form. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Holly Scheller gentlemovecolon@gmail.com 317-828-7384 | 5K Run/Walk Male & Female Awards: Top Overall Age Groups (top 3) 9 & under 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+ |
| 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: YM, YL, SM, MD, LG, XL, XXL |
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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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |