16th Annual Get Physical 5k Run, 1.5 mile Charity Walk and 1/2 mile Kids Run


Lebanon Physical Therapy
272 Highland Dr
Lebanon, VA 24266, Lebanon, VA

8/12/2022


Friday evening
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

16th Annual Get Physical 5k Run, 1.5 mile Charity Walk and 1/2 mile Kids Run

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

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.

SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)


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