DrS. McIntyre and Whiting’s
Miles for Smiles 5K Run/ Walk
to benefit Dentistry from the heart
August 17, 2013 8:00 AM
Location:Race will begin at Wilbur Pence Middle School 375 Bowman Road Dayton, VA 22821. Participants will enjoy the beautiful, historic outskirts of the town of Dayton, traveling through the peaceful countryside.
Awards: Awards will be given to the top two division winners male and female. Age divisions are as follows: 12U, 13-15, 16-19, 20-29, 30-39, 40-49, 50-59 and 60 and over.
Entry Fee: 5K adult early entry fee is $25.00 if postmarked by August 2, 2013 and $30.00 on race day. Participation fee for youth under age 18 is $20.00. All proceeds from this event will go directly to fund Dentistry from the Heart, a national non-profit organization which enables us to hold a free day of dentistry at our office, September 28, to offer those less fortunate the dental care that they so urgently need.
Race Day: Registration begins at 7:00 am. Race begins at 8:00 am. T-shirts guaranteed to participants who pre-register. Day of registrants will receive a T-shirt on a first-come first-served basis.
Questions: Contact race director, Tamara Barnard via email at or phone at 540-828-2343. Visit our website or check out the event on our Facebook page more information.
(Detach, Sign, and Mail)
Name:______Sex: M / F Shirt Size:_____ AGE as of 8/17/2013______
Address:______Phone:______
CIty: ______State: ______Zip:______
Participant Waiver: I understand that participating in this 5K run/walk is potentially hazardous and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur during the event or while I am on the premises of the event. I am also aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic and conditions of the race path. I agree to abide by any decisions by race officials. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitle to act on my behalf, waive and release Drs. McIntyre and Whiting, the event organizers, the town of Dayton, VA and/or the county of Rockingham, all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the event. Furthermore, I agree to be bound by the rules established with respect to this event. I understand that if the race is canceled by circumstances beyond the control of the organizers, my entry fee will not be refunded. I grant permission to all the foregoing to use photographs, motion pictures, recordings, or other record of this event for any legitimate purpose.
SIGNATURE______DATE______
PARENT/GUARDIAN______DATE______(If entrant is under age 18 years of age)
Please make checks payable to:
“Smiles for Life” and mail,postmarked by 08/02/2013to:
Miles for Smiles 5K, 115 Oakwood Drive, Bridgewater, VA 22812