8:45-9:15am - Day of registration 9:30am- Special Needs Dash (All special needs participants will receive a medal) 10:00am- 5K Run/Walk Pre-registration: $20 13 years and up, $10 12 years and under, $5 All Special Needs (ends 4/26/20) Virtual - $25 13 and up, $15 12 and under, Special needs $5 Day of: $25 13 and older, $15 12 and under, $5 all special needs REGISTER BY April 10th TO GUARANTEE A SHIRT IN YOUR SIZE Early Packet Pick-up: Friday, April 30th - ETSU Quad (lawn at Brooks Gym) Water, bananas and granola bars will be waiting for each participant as they finish! Hosted by FRIENDS (Friends Reaching, Inspiring, Educating Neighbors about Down Syndrome) |
| Pre-registration: (ends 4/26/2021) |
$20 Ages 13 and up $10 Ages 12 and under $5 All Special Needs Participants | | Regular | Registration: |
$25 Ages 13 and up $15 Ages 12 and under $5 All Special Needs Individuals | |
| Make checks payable to: FRIENDS | ||||
| Mail this form to: PO Box 5677 Johnson City, TN. 37602 | ||||
| All special needs dash participants will receive a race medal |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Misty Adams mistyadams2@gmail.com 865-898-7828 | FRIENDS Buddy Run 5K & Family Walk Male & Female Awards: Overall (top 3) Age Groups (top 3) ...9,10-19,20-29,30-39,40-49,50-59,60... | Special Needs Dash Male & Female Awards: ...0,0... |
| 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: FRIENDS Buddy Run 5K & Family Walk | Special Needs Dash |
*** CIRCLE SHIRT SIZE: YS, YM, YL, 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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |