Everyone is encouraged to pre-register by Friday, December 2nd

8^th Annual Jingle Bell Run 5k/1 Mile Fun Run

Blountstown Middle School

Event Overview: Long-sleeved technical shirts (for the 5K) and jingle bells will be provided while supplies last. Everyone is encouraged to pre-register by Friday, December 2^nd to guarantee a shirt. Registration will be set up at BMS on race day beginning at 5 PM. Registration fee is $20. The 1 Mile Fun Run will be free and all kids will receive a medal for participating. (NO Fun Run shirts)

Date: Friday, December 9, 2016 (Make-up Date: to be determined)

Make checks payable to BMS $20 Paid:____ Time: The race will start at 6 PM CST.

REGISTRATION INFORMATION (Please complete one form per participant)

Name:________________________________________________________________________________

Address:______________________________________________________________________________

Phone number:_____________________________ email:_____________________________________

Birth date:________________________ Age:______________ Sex:_____________

Please check one: 5K:______ Fun Run:______ 5K T-shirt size (circle one): S M L XL 2XL

Registration form and money are due by Friday, December 2, 2016 to ensure a shirt.

Please sign the waiver statement below for each participant, including children:

I, the undersigned, in consideration of acceptance of the entry and registration as participant in the Jingle Bell Run, waive any and all claims which I and my heirs or assigns may now or hereafter have against BMS, the City of Blountstown, and all officials, volunteers and sponsors of the Jingle Bell Run, which may indirectly or directly result from my participation in the Jingle Bell Run. I further warrant and represent that I am in proper physical condition to participate in the Jingle Bell Run and am not participating in this event against physician’s advice nor am I taking medications which could impair my health or ability to participate in the Jingle Bell Run. Further, I grant my permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for legitimate purposes.

Signature (parent /guardian if under 18)____________________________________________Date:_____________

NO CHILDREN UNDER THE AGE OF 18 MAY PARTICIPATE WITHOUT THE PRESENCE OF A PARENT/GUARDIAN. FULL RESPONSIBILITY OF THE CHILDREN WILL LIE ON THE SUPERVISING ADULT.

You may drop off your registration form and money to BMS front office (674-8234) or mail it to:

Nicole Purvis

C/O Blountstown Middle School

17586 Main St. North

Blountstown, FL 32424