Kids race - 9 a.m. 5k race - 9:15 a.m. Packet Pickup Saturday – 8-9 a.m. Location TBD |
| Pre-registration: (ends 12/27/2021) |
$30 through Dec. 17 | | Regular | Registration: |
Packet pickup and late registration - $35 Dec. 18 | |
| 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 | 5k Race Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) 11-19,20-29,30-39,40-49,50-59,60-69,70+ |
| 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 |
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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) |