5k Trail Run 8:00 am and 1 mile walk 9:00 am 2

October 23,2010 1800 Wilson Pkwy 2

Don Davidson Park, Fayetteville, Tennessee

Mail Application to: For more information contact Helen Fussell,
Imagination Library 5K
P.O. Box 914
race director, at fussellh@gmail.com or 931-580-3081
Fayetteville, TN 37334 Website: http://imaginationlibrary5k.blogspot.com/
or http://trailsforkids.blogspot.com/
Name: (first)_________________________(last)_____________________________ 2

Male p Female p
Address:____________________________________________________________
City:_________________________ State:_________ Zip code:___________
Phone:(____)________________ Age on Race Day:________ Birthdate:___________
Email:__________________________________
2
T-Shirt Size: Youth, S, M, L, Adult, S, M, L, XL, 2XL
Race Waiver: I, individually, (and/or as parent or guardian of named minor), for and in
consideration of acceptance of this entry in the aforementioned even, do hereby release, remise,
waive, and forever discharge the Imagination Library, Trails for Kids, the City of Fayetteville,
and any and all other supporting groups of this said racing event, together with all their officers, Mail and online registration closes
agents, officials and employees, from any and all liability, claims, demands, actions, or causes of action October 9, 2010
whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to
Race day registration:
participation in the aforesaid event. I further state that I am in proper physical condition to participate in
this event. In addition, I agree that my participation in this event requires that I will not participate with baby $25 for 5K
joggers, animals, or anything which the race director deems dangerous to myself or others. I further grant $15 for 1 mile run run/walk.
permission to this race and the organization conducting the race to use my photographs, and any other record
of this event for any purpose. I also agree that if the event is canceled for any reason that all entry fees are non-refundable.
Signature ____________________________
(Parent/guardian for entrants under 19 years)
Date ______________________________