SATURDAY DECEMBER 5 2015 MIDWAY MIDDLE SCHOOL at

SATURDAY, DECEMBER 5, 2015 MIDWAY MIDDLE SCHOOL at 9: 30 am by the tennis courts Midway Middle School PTA Jingle Bell Run 5 K & 1 Mile Run/Walk 2015 Pre-Registration Form Deadline November 20 th Last Name: ____________First Name: ______________ Address: _______________City: _______Zip: ______ Phone: ____________Email: _____________Grade: _____ Male: _____ 1 st Annual Event Proceeds: Benefit MMS Students & Faculty for our ONLY fundraiser 20 th Entry Fees: Pre-Registration: $25 Register after Nov Pay $30 Registration online at https: //runsignup. com Pre-Registration Packet Pickup, December 4 th at MMS 3: 15 pm-6: 00 pm Registration at 8: 30 am, 5 K Run at 9: 30 am, 1 Mile Run/Walk at 9: 45 am, Awards: 5 K 1 st Place M/F, 1 st Place 7 th & 8 th Boy & Girl, 1 st & 2 nd Place in other age divisions plus BEST holiday COSTUME award; No Duplicates Amenities: Custom awards by Practically Pikasso, Timering Chip Technology by Pro-Fit Event Services, warm up music, MC Ed Sorensen, and sponsored water stations Course: Approved by city of Waco and Hewitt Female: _____ Birthdate: ______/______ Age: _______ Participant Waiver: I, the undersigned, assume full & complete responsibility for any injury or accident, which may occur during my participation in the event or while I am on the premises of the event. I hereby release & hold harmless MMS PTA Jingle Bell Run/5 K, Midway ISD, Midway Middle School PTA, Pro-Fit Event Services, the sponsors, and entities associated with the event or their agents or employees including all injuries & damages which were caused by negligence of the released parties. I will not enter & participate unless it is medically safe for me & I am properly trained. I also know that although protection services will be provided, there may be traffic on the course route. I assume all risk associated with this event, including but not limited to falls, contact with other participants, the effects of weather, including heat and or humidity & rain, cold & the conditions of the road, all such risks being known & appreciated by me. I further grant my permission to use any photographs, videotape, motion pictures, recordings, or any other record of this event that includes Myself. T-shirt is not guaranteed. Fees are non-refundable. I have read the forgoing & certify my agreement by this signature, & my parent/guardian’s signature if under 18 years of age. Student Signature: _____________Parent/Guardian: ______________Date: ____ (Entry invalid if not signed) o o o o o (If under 18 years) Please make checks payable to “MMS PTA” I’ll run/walk 1 mile for a $25 pre-reg fee that includes 2 MMS TARDY passes I’ll run a 5 K for a $25 pre-reg fee that includes 2 MMS TARDY passes My Adult T-Shirt Size: XS S M L XL XXL Please circle one carefully! Pre-Registration Packet Pick Up on Friday, December 4 th at MMS 3: 15 pm -6 pm I’m busy/out of town/just not a runner, but I’ll support the school for $25 attached!! I’ll sponsor a MMS student who can’t afford to run for a $25 reg fee attached. I would like to sponsor the MMS PTA Jingle Bell Run: __$150 Mile Marker Sign___$500 T-Shirt Sponsor__$1, 000 T-Shirt&Display Banner I’d like to volunteer at this event!! My cell number is______________ Any questions, please email kmiller@bigcreekconstruction. com