Health Fitness Youth Runs
Eastman Road Race
Sept. 7th, 2012
Eastman Ball Fields
Wilcox Drive, Kingsport,TN
Fee: $5 thru 8/31... $10 after

3:30 Late registration and packet pickup @ softball fields
5:30 Warm ups
6:00 Races begin
4:30-8pm: Pasta dinner

Participants will run the following distances:
2-3yrs: 75yds / 4-5yrs: 150yds / 6-7yrs: 300yds / 8-9yrs: 1/2 mile / 10-11, 12-14yrs: 1 Mile

Ribbons for all finishers
Medals for top 3 M/F
Free pasta dinner for all runners, extra dinner tickets $2 at the door
Community Participation Awards: 4 categories: Church / School / Senior Club / Youth Club.
Win $ for your org by competing or volunteering. Organization with the most participants in each category will win $5/person up to $500. You must enter CATEGORY and ORG.NAME below.

School Rebates: In addition to Community Participation Awards, each elem/middle/high school will receive $1 for each student participant. Min. of 10 students. Enter SCHOOL NAME below.

 For more info contact Amber Nave  423-224-0836 (days) or visit www.EastmanRoadRace.com

Mail this form and check payable to ERC to:
    Eastman Road Race
    Toy F. Reid Employee Center
    Kingsport, TN 37662-5310
Health Fitness Youth Runs - Eastman Road Race

LAST NAME_______________________________________  FIRST NAME______________________________________

SEX______       AGE ON RACEDAY______                 DATE OF BIRTH___/___/___

ADDRESS______________________________________________________________________

CITY______________________________________   STATE______   ZIP______________

PHONE (______)______-____________    EMAIL______________________________________________

SHIRT: YS, YM, XS, SM, MD, LG


STUDENT? SCHOOL NAME:____________________________

COMMUNITY PARTICIPATION AWARDS:     Org Name: ___________________________________
                                     Category:  CHURCH / SCHOOL /  SEN.CITIZENS /  YOUTH CLUB

 IN SUBMITTING 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.
SIGNATURE______________________________________________ DATE________________
(Parent signature if under the age of 18)