The 1st UPPER CUMBERLAND 5K COLOR RUN

Saturday, Apr 20th - 7:00am - 9:00am
This is not your average 5k; it’s going to bethe most colorful race you’ve ever run in!
  All Participants Wear White T-Shirts
For More Information Call 823-7761
Saturday, April 20, 2013 @ 7:00am Pre-Registration $35.00/
Registration day of race$40.00
 By April 1st
*
 All proceeds benefit students of OC Adult Education*
**************************************************
 Name____________________________________________________________________________ 
 
 Address__________________________________________________________________________ 
E-Mail________________________________________________
Gender: Male / Female Age______________
Shirt Size: YM YL AS AM AL AXL (all forms received by April 1st guaranteed a t-shirt)
 _______________________________________________________________ 
 
 WAIVER OF LIABILITY-PLEASE READ CAREFULLY!I understand, intending to be legally bond, hereby, hereby, for myself, my family, my successors, assignees, heirs,executors, administrators, foever wavied, release and discharge any and all rights, claims for damages,causes ofaction whether in law, equity, or otherwise, known and unknown, that I or any of them, may have against the Paint aBrighter Future 5K, Overton County Adult Education, Overton County School System, The City of Livingston, and theirofficers, directors, employees,volunteers, representatives, successors and assignees, for any injuries, illnesses, orany other harm suffered by me in or as a result of this event. I understand that there will be no refunds if eventscannot be staged or is cancelled for any reason. We reserve all rights to cancel this event and shall not be liablefor any actual or consequential damage. I attest that I understand precautions must be taken when running in warm orcold conditionsand on uneven surfaces. I will abide by the decisions of any race official. I also agree to abide byany decision of an appointed race official or medical official relative to my ability to safely continue or completethe event. I further assume that I will pay my own medical and emergency expenses in case of an accident, illness, orincapacity regardless of whether I have authorized such expenses. I have read this waiver carefully and understand it.IF ATHELETE IS UNDER 18years of age- The signature certifies that my son/daughter has my permission to participate inthe Paint a Brighter Future 5K Run. The signature has read the foregoing RELEASE AND WAIVER OF LIABILITY AGREEMENT(above) and by signing intentionly and voluntarily agrees to its terms and conditions. The signature furthercertifies that my son/daughter is in good physical condition and is able to safely particiapate in the Paint aBrighter Future 5K Run. I hereby authorize medical treatment for him/her and grant ac
cess to my chid’d medical
records as necessary.
SIGNATURE____________________________________Date___________ 
(Parent or Guardian if under 18)
Please mail registration form and payment to
Overton County Adult Education
112 Bussell Street
Livingston, TN 38570

Online Membership PBS Logo 125X125 More Ways to Support WCTE

WCTE depends upon the support of our membership to produce and broadcast quality programming like this. Please help us continue this 30+ year tradition of community involvement by contributing to WCTE today.

share