Jingle 5k


King Commons, Founders Park, Johnson City, TN

12/11/2022


Start time:
5k race - 6 p.m.
Kids race(ages 6-9) - 5:40 p.m.

Packet Pickup:
3-5:45p.m.

Downtown JC - King Commons/Founders Park

Pre-registration:
(ends 12/8/2022)
5k - $30 through Dec. 10
kids - $25 through Dec. 10
| Regular
| Registration:
late registration -
5k - $35 Dec. 11
Kids race - $30 Dec. 11
Make checks payable to: The Goose Chase
Mail this form to: Jingle 5k
3101 Browns Mill Rd
Suite 6-182
Johnson City, TN 37601
Please circle here for 3XL shirt.
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Karen or Ashley
info@thegoosechase.org
423.946.0519
Kids Race
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
Top 3 male & female (ages 6-9)
5k Race
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters

Age Groups (top 3)
10-19,20-29,30-39,40-49,50-59,60-69,70+

Jingle 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 EVENT: Kids Race | 5k Race

*** CIRCLE SHIRT SIZE: 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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