4th Annual 5K Jingle Bell Jog & 1 Mile Rudolph Run

Saturday, December 7th, 2013 5K starts 8 a.m. @ Prescott South Elementary School 1 Mile Rudolph Run 9 a.m. in PSES parking lot 5K: $24.00 Pre-Registration/ $29.00 Day of Race 1 Mile: $15.00 Guaranteed t-shirt if registered by November 21st For more information contact: (931)260-9300 (Lynsey Jones-Harris) *All proceeds benefit Prescott South Elementary School* ------------------------------------------------------------------------------------------------------------------5K ____

1 Mile Run ____

Parents may participate in 1 Mile Rudolph Run w/ child at no additional cost. Name: _____________________ Age ____ M( XL

)

F(

) T-Shirt Size: S

M L

2X 3X 4X (Specify __YOUTH or __ADULT

size) Address: _________________________________ City: ___________________ State: ______ Zip: ______________ Email: ____________________

Waiver (All participants must sign) I hereby waive all claims for myself, my heir, and executors against the City of Cookeville, Prescott South Elementary and all sponsors and promoters of the PSES Jingle Bell Jog and Rudolph Run for injury or illness, which may result from my participation. I hereby grant permission for the free use of my name and picture in broadcast, brochure or account of this event. Signature and Date: _______________________________________ (Parent or Guardian if under 18)

Please mail registration forms to: Prescott South Elementary School ATTN: 5K Jingle Bell Jog 115 West Cemetery Rd. Cookeville, TN 38506