September 24, 2016

One mile fun run: 8:00

5k: 8:30
Race Location: Downtown Blue Ridge
Cost: $25-Make checks payable to: BRES PTO
Return to: BRES, Woodmen Life or Terra Outfitters

Registration Form
Running 5K - Individual Age Group/Open
First Name: ______________________________
Date of Birth: _________________

Last Name: ____________________________

Gender: M or F

Phone: __________________________

Email: ___________________________________________________________________________
Address: _________________________________________________________________________
City: _________________________________ State: __________ Zipcode: _________________
T-shirt size: S

XL

XXL

YS

YM

*Registration after Sept. 10 does not guarantee desired t-shirt size

Emergency Contact Name: ______________________________________

Emergency Contact Phone: ______________________________________
Liability Waiver: I hereby release and agree to hold harmless, Blue Ridge Elementary School, Fannin County Board of Education, our
sponsors, representatives, volunteers, and employees of them all of any and all liability, loss, claims, and demands that may occur from
any loss damage, or injury (including death to my person or property) in any way resulting from, or arising in connection with this event,
and whether arising while engaged in competition or practice or preparation therefore, or while upon entering or departing from said
premises, from any cause whatsoever. I know and accept the risk and danger to myself and my property while upon said premises or
while participating or assisting in this event, so voluntarily and in reliance, upon my own judgment and ability, and I hereby assume all
risks for loss, damage, injury (including death to myself or my property) from any cause whatsoever.

Participant Signature :_______________________________________

Parent/Guardian Signature (if participant under age 18): __________________________________