Pre-registration: (ends 8/31/23) |
$30 - YMCA Members (ages 16 over) $35 - Non-YMCA Members (ages 16 over) $5 - Ages 10-15 Free - Ages 9 under | | Regular | Registration: |
$40 - YMCA Members (ages 16 over) $45 - Non-YMCA Members (ages 16 over) $10 - Ages 10-15 Free - Ages 9 under | |
Make checks payable to: Greater Kingsport Family YMCA | ||||
Mail this form to: Greater Kingsport Family YMCA 1840 Meadowview Parkway Kingsport, TN 37660 |
Headphones are permitted on the course | Strollers are permitted on the course |
For more info contact Danielle Puckett, dpuckett@ymcakpt.org, 828-719-7764 | 5K Run/Walk Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) 1-9, 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: YS, YM, YL, 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) |