Saturday, May 25, 2013 -- Hurricane, WV / Hurricane Wave Pool Park
West Teays Elementary Chasin' Summer 5K
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RACE CONTACT: Tom Smith (email)
$20.00 pre-registration by May 6, 2013 . . . $25.00 after May 6, 2013 ... Only pre-registered participants are guaranteed a T-shirt.
Checks payable to: West Teays Elementary (Write 5K Race in Memo Space please)
Mail completed entry form to:
West Teays Elementary School (Attn: Assistant Principal)
NAME_______________________________________________________________
MAILING ADDRESS____________________________________________________
___________________________________________________________________
PHONE______________________________________________________________
EMAIL______________________________________________________________
Age Day of Race____
Discalimer: "Must be signed or entry will not be accepted. In consideration of the acceptance in the Chasin Summer 5K Run/Walk, I undersigned, intending to be legally bound, herby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the City of Hurricane, WV, West Teays Elementary School, and any other individuals and organizations assisting with the Chasin Summer 5K walk, and for any and all injuries suffered by me in this event. I attest and verify to the best of my knowledge, my physical condition and fitness are adequate for me to safely compete an no physician or qualified individual has advised me against competing in this event."
__________________________________________________________________
3676 Teays Valley Road
Hurricane, WV 25526
AGE BRACKET: _____12 & Under /_____13-19 /_____20-29 /_____30-39
_____40-49 /_____50-59 / _____ 60+
GENDER: ____Male or ____Female
T-Shirt Size : __________
Only pre-registered participants are guaranteed a t-shirt
Signature (Parent/Guardian must sign if under 18)