Scarecrow Skedaddle

Founders Park (Great Lawn entrance)
225 Commerce St, Johnson City, Tennessee 37604, Johnson City, TN

10/23/2022

This 5k & 1-Mile Run is brought to you by Niswonger Children's Hospital. A Modified Race (200-meter) will begin at 1:45 p.m. with the 5k starting at 2 p.m. and 1-Mile Run starting at 2:10 p.m. The event is open to all ages. The entry fee is only $10.

*Modified Race is for kids who may need assistance with wheelchairs and/or walkers.

Pre-registration: (ends 10/23/2022)	Only $10!!
Make checks payable to: Ballad Foundation *Memo - Scarecrow Skedaddle
Mail this form to: Scarecrow Skedaddle Attn: The Goose Chase 3101 Browns Mill Road, Ste. 6-182 Johnson City, TN 37604

Please check our website for updates
www.scarecrowskedaddle.com

Headphones are permitted on the course | Strollers are permitted on the course

For more info contact
Event Management by The Goose Chase
423-946-0519 or info@thegoosechase.org

5k
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters

Age Groups (top 3)
9 & Under, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 & Older

1 mile
Male & Female Awards:

No awards given

Scarecrow Skedaddle

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 EVENT: 5k | 1 mile
*** 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)

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