The 2012 Stone County
5K Jingle Bell Run
Kids 1 mile Fun Run
Date: Saturday, December 8, 2012
Place: Wiggins, MS (begins at the foot of Historic Pine Hill
Near Blaylock Park in Downtown Wiggins)
Time: 8:00am - 5K Run & Kids 1 mile Fun Run
Entry Fees:
$20.00 Pre-Registration/$25.00 Day of Race (Race Day Registration Begins at 7 a.m.)
$10.00 Kids 1 Mile Fun Run or a toy donation to the Cops for Kids
Awards/Medals:
Long Sleeve T-shirt – Pre-register to guarantee t-shirt availability.
Special prizes for Best Dressed runners, so celebrate the season!
Medals to Overall Male, Overall Female, 1st, 2nd and 3rd Place in each age groups.
Male:
19 and Under___
Female: 19 and Under___
20-29___
20-29___
30-39___
30-39___
40-49___
40-49___
50-59___
50-59___
60+___
60+___
GENERAL INFORMATION: We invite your entire family to come and enjoy the holiday season in Stone
County, including the 5K Run, Breakfast with Santa, Arts and Vendors in Blaylock Park, the Christmas Parade
and great local merchants with unique Christmas gifts. It’s great family fun all day and we hope to see you on
Saturday, December 8, 2012.
For more information on the Race or Christmas in Stone County, please call the Stone County Economic
Development Partnership @ 601-928-5418 or visit our website @ www.stonecounty.com
To Register:
Name: ________________________________ 5K Run______ Kids 1 mile Run ________
Address_________________________________City_____________State_____Zip__________
Age_______
Birthday____/____/____
Sex:
Male____ or Female____
Long Sleeve T-Shirt Size for 5K Run Participants S___ M___ L___ XL___ XXL___
RELEASE WAIVER
IN CONSIDERATION OF YOUR ACCEPTANCE OF MY ENTRY OR MY MINOR CHILD IN THIS EVENT, I INTEND TO BE LEGALLY BOUND FOR
MYSELF OR MY MINOR CHILD. THEREFORE, MY HEIR EXECUTORS AND ADMINISTRATORS DO HEREBY RELEASE AND DISCHARGE
STONE COUNTY ECONOMIC DEVELOPMENT PARTNERSHIP AND THE PINE HILL FESTIVAL OFFICIALS AND ANY AND ALL SPONSORS
FROM ANY AND ALL LIABILITY ARISING DUE TO ILLNESS, INJURY, DAMAGES AND DEATH THAT I MAY SUFFER AS A RESULT OF MY
PARTICIPATION IN THESE EVENTS. I CERTIFY THAT I AM IN GOOD PHYSICAL CONDITION TO PARTICIPATTE IN THE 5K and 10K
EVENTS.
_______________________
Print Name
_________________________
Signature
___/___/___
Date