Jingle Bell Jog
The city of Beaver Dam and the Family Wellness Center will host the Jingle Bell Jog 5K Walk/Run on December 2, 2017 at 8:00am. Make checks payable for registration to Family Wellness Center. Contact Brandy at 270-298-4500 or email
for more information. Race will begin and end behind Hope for Life Women's Resource Center in downtown Beaver Dam. Early Bird registration ends November 18th and is $15. After November 18th, Registration fee is $20. The day of the race registration is $25. Race begins at 8am. T-shirts will be given to Early Bird Registrants ONLY.
Date of Birth
Address: (Street, City, State, Zip Code)
T-Shirt size (early bird registrants ONLY)
Agreement of Release and Waiver of Liability
By typing my full name at the bottom of this agreement, I hereby agree to the following: 1. That I am participating in the Jingle Bell Jog race, or alternate instruction during which I will receive instruction on running and fitness. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participating in the 5K race. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in this class. 3. In consideration of being permitted to participate in the 5K race. I agree to assume full reponsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program. 4. In consideration of being permitted to participate in the 5K race, I knowingly, voluntarily, and expressly waive any claim I may have the Ohio County Family Wellness Center, or any instructor for injury or damages that I may sustain as a result of particpating in the program. 5. I, my heirs or legal representatives forever release, waive, discharge, and covenant not to sue the Ohio County Family Wellness Center, or any associate/instructor of the 5K for any injury or death caused by their negligence or other acts. I have read the abover release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
Please type your full name to state your agreement to the terms and conditions above. (Parent must do so if child is under 18 years of age.)
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