| Pre-registration: (ends 9/3/22) |
$10.00 (High School and under) $15.00 (All others) (Adults) $1.00 discount to SFTC Members | | Regular | Registration: |
$12.00 (High School and under) $20.00 (All others) | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: Baileyton Celebration 5K | ||||
| Mail this form to: Bronson & Shelia Carter 1455 Lost Mountain Pike Greeneville, TN 37745 | ||||
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Bronson & Shelia Carter 1455 Lost Mountain Pike Greeneville, TN 37745 423-972-8187 bsbtcarter@gmail.com | Baileyton Celebration 5K Male & Female Awards: Top Overall Top Masters Age Groups (top 3) .....11,12-15,16-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69, 70 and older |
| 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, 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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |