Color Run
5K Run/Walk
Saturday, February 14th
CHS Dragon Baseball Field
Race begins at 9:00 a.m.
Collierville Baseball Dragons’ Dash 5K Run/Walk
February 14, 2015 9:00 AM
Collierville High School Baseball Field
Registration Form
One registration form is required per participant.
I plan to: _____Run ____Walk
Last Name ______
First Name______
Address______
City______State______Zip______
Phone______Email______
Date of Birth____/____/______Gender______
T-Shirts will be provided to all pre-registered runners. Those registering on race day will receive shirts on a first-come first-served basis. Available sizes are:
YOUTH: M LADULT: S M L XL XXL
(Circle One)
Payment
____Adult Pre-registration until 2/01/15 $30.00
____Child (12 and under) Pre-registration until 2/01/15 $25.00
___Enclosed is my check for $______payable to the
Collierville High School Baseball Booster Club
Waiver: I hereby declare, assert and affirm that participation in Collierville High School Baseball Dragons’ Dash 5K Run/Walk is done having voluntarily and knowing assumed ALL RISKS involved in this Special Event. The immediate physical risks and hazards associated with normal, vigorous physical activity include (but are not limited to) physical discomfort, fatigue, muscular soreness, falls, pulled or strained muscles, overuse injuries, heat stress, and the rare instance of abnormal responses of the cardio-respiratory system including heart arrhythmia, heart attack, stroke, and sudden death. In consideration of acceptance of this contract allowing my participation in the above stated Special Event and intending to be legally bound thereby, I hereby for myself, my heirs, executors, administrators and assigns, WAIVE AND RELEASE any and all rights and claims for negligence, injuries, damages or losses that I may incur against all participating agencies involved in the above stated Special Event, and their respective employees, agents, representatives, successors and assigns, for any and all activities connected with the above Special Event. I also understand that I do hereby WAIVE any and all rights or benefits under the State of Tennessee Worker's Compensation laws for any injury incurred as a result of my participation in this event, including disregard of the posted route.
Print Name______
Date ______
Signature______
Parent/Legal Guardian must sign ifparticipantis under the age of 18
For questions please contact Jeff Tow at 901-305-1075
Send your completed form with payment to:
Jeff Tow
1390 Riverbranch Cove
Collierville, TN 38017
You may also send in/drop off forms and payment to the following people at the stated Collierville School. Please make sure registration packet has the person’s name on the outside.
Michelle Sutton Crosswind Elementary
831 West Shelton Road
Collierville, TN 38017
Libby Green Collierville Elementary
590 Peterson Lake Road
Collierville, TN 38017
Amy GarciaSchilling Farms Middle School
935 Colbert Street
Collierville, TN 38017
Jeff Munier Collierville High School
1101 New Byhalia Road
Collierville, TN 38017
Race packets will be available for pick up on Friday,
February 13th from 4:00- 7:00 p.m. in the CHS library. You may also pick up packets on race day, February 14th from 7:00- 8:00 a.m. at the packet pick-up tent.