9:00 a.m. Race Start |
| Pre-registration: (ends 5/12/21) |
Jan. 1-Feb. 28: $30 March 1-April 14: $35 April 15-May 15: $40 Part of the SFTC Trail Series | Make checks payable to: Norton Friends and Farmers Market
| Mail this form to: Fit Farmer 12K Trail Run, City of Norton, C/O Katie Dunn, P.O. Box 618 Norton, VA 24273
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| Race benefits the Norton Friends and Farmers Market. Race also part of the High Knob Triple Crown series (www.highknobtriplecrown.wix.com/hktc. |
| Headphones are permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Katie Dunn, katied@nortonva.org, (276) 679-1160 | Fit Farmer 12K Trail Run Male & Female Awards: Overall (top 3) Top Masters Age Groups (top 3) 29 & Under; 30-39; 40-49; 50-59; and 60 and over |
| 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: 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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |