6:30 PM 1/5 mile Charity walk 6:40 PM 1/2 mile kids run (11 and under) 7:00 PM 5k Run Our fun and challenging race returns after two year Covid hiatus. Our proceeds go to support Russell Count Schools "Food for the Holidays" program. Come join us for a great Friday night race. Food, door prizes and music.. 6:45 |
| Pre-registration: (ends 8/11/2022) |
$25 for pre-registration | | Regular | Registration: |
$30 | |
| Make checks payable to: Lebanon Physical Therapy | ||||
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Call Lebanon Physical Therapy for more details 276.889.4090 | Get Physical 5k Male & Female Awards: Overall (top 3) Masters (top 3) Age Groups (top 3) 14 and under, 15-19, 20-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60 and up |
| 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, XS, 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. 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) |