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Burch Bear Tracks Race
Proceeds benefit JDRF
and Burch Track Fund
Saturday, March 21, 2015
Race will be held on the Sandy Creek High School Cross-country course
1M
ile -
5K -
.
8 a.m
.
a.m
.
8:30
0 a.m
4
:
8
-
Directions: From the North: Take I-85 South; exit 61 (Hwy 74: Peachtree City/Tyrone);
turn left at top of exit ramp; proceed south on Hwy 74 to Jenkins Rd; turn left; Burch
will be on the right. From Peachtree City: Go north on Hwy 74 to Jenkins Rd; turn
right; Burch will be on the right. From the East: Go west on Hwy 54 to Sandy Creek Rd;
turn right on Sandy Creek Rd; go to Ellison (just before RXR tracks); turn left on Ellison;
turn right on Jenkins Rd; Sandy Creek High School will be on the left.
Packet pick-up at R.J. Burch
Friday, March 20th ,
from 12 p.m.—6 p.m.
$15 if received before
Deadline to guarantee t-shirt :
Monday, March 10th
March 6th
$20 after March 6th and
race day
Part of the Rotary
Grand Prix Series
Trot
t
o
T
Name: ______________________________________ Birth Date: _________________ Age: _____ Event:
Visit
www.burchbears.org
for more information
Tot Trot
1 Mile
5K
Event:
Tot Trot
1 Mile
5K
Event:
Tot Trot
1 Mile
5K
Event:
Tot Trot
1 Mile
5K
Shirt Size: YS YM YL AS AM AL AXL
Name: ______________________________________ Birth Date: _________________ Age: _____
Shirt Size: YS YM YL AS AM AL AXL
Name: ______________________________________ Birth Date: _________________ Age: _____
Shirt Size: YS YM YL AS AM AL AXL
* Name: _______________________________________Birth Date: _________________ Age: _____
$10 No Shirt—Running Only
Family Address __________________________________________________ City _______________________________ State ______ Zip __________________
Email Address ______________________________________________________
Phone ________________________________
Only Cash or Checks; payable to: R.J. Burch Elementary—330 Jenkins Road, Tyrone, GA 30290; 770-969-2820
Total Enclosed $_______________
WAIVER: I know that running a road race is potentially hazardous. I should not enter and run in this event unless I am medically able and properly trained. I also know that, although vehicles are not normally allowed along the racecourse, there may be traffic on
the course. I assume the risk of running in traffic. I agree to abide by any decisions of a Race Official relative to my ability to complete the run safely. I assume all risks associated with running this event including, but not limited to, falls, collisions with vehicles,
bicycles and pedestrians, contact with other participants, dog attacks, the effects of weather, and the condition of the roads, all such risks being known and appreciated by me. I agree not to wear headsets, bring a pet, use roller blades, ride scooters or bikes and
that no exceptions to this rule will be made. Strollers and wagons are allowed only during the walk and only if they are behind all other participants. I attest that I am physically fit and sufficiently trained to participate in this run. Having read this waiver and
knowing these risks and in consideration for the acceptance of my entry, I hereby, for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue and waive, release and forever discharge Robert J. Burch Elementary School, all race management personnel, and other individuals and groups involved in this event, known and unknown. I also grant permission to all of the foregoing to use any photographs, motion pictures, recording or any other record of this event for any
legitimate purpose. Any runner responsible for causing a hazardous condition will be disqualified. The official race director reserves the right, in the event of emergency or local or national disaster, to cancel the race or to change the day and/or time to a later day
and, in the event of cancellation or change, there will be no refund of entry fees. DISCLAIMER: In the interest of safety, the race directors reserve the right to withdraw from the race any runner who, for whatever reason, appears to be experiencing difficulty in
finishing.
Signature of Participant or Parent/Guardian if under 18 years of age: _________________________________________________ Date: ____________