nu 5t h

al Watsontown JesVic 5K
In loving memory of Jessica Wade and Vicki Hitesman R ac e
&
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Supporting local families facing disease and medical bills

Wa l k
Date: Saturday, June 4, 2011 Awards
Time: 5K at 9 a.m.
Kidsʼ 1/2-mile starts around 10 a.m. Top three overall finishers, top three in each
5K registration closes at 8:45 a.m. age group are awarded, and the top masters
Place: Watsontown Elementary School finishers are awarded.
1100 Main Street, Watsontown, PA 17777
Age Groups: 30-34 55-59
Kids’ 1/2-Mile Race 14 and Under 35-39 60-64
Must be 12 and under 15-19 40-44 65-69
All participants receive a ribbon. 20-24 45-49 70 and Over
Top 3 boys and Top 3 girls of each age group 25-29 50-54
awarded: 8 and Under 9-12

Registration Instructions Make checks payable to: Watsontown 5K

Option 1: Pre-registration Mail check or cash and completed form to:
5K $15 Kidsʼ 1/2-mile $10 Watsontown JesVic 5K
Must be received by May 28. Kipton Hoffman
Family rate: Families with at least four 4 Whitetail Lane
members pre-registering can register for $10 Watsontown, PA 17777
each member. All registration forms must be
mailed in the same envelope.
Questions? Contact a race director at
Option 2: Race-day registration
JesVic5K@gmail.com.
5K $20 Kidsʼ 1/2-mile $15
Website and blog: http://jesvic5k.org
Race-day registration is open from 7:15 a.m.
Like us on Facebook at “JesVic.”
until 8:45 a.m.
Follow “JesVic5K” on Twitter.

Name (First, Last): ____________________________________ Gender: F M

Address: ___________________________________ Age on race day: _______
___________________________________ Email: _______________________
Event: 5K race 5K walk Kidsʼ 1/2 mile
T-shirt size: S M L XL XXL No Thanks
1. JesVic offers daycare services starting at 8:30 a.m.. Please pick up your children by 9:45 a.m. If
bringing children for daycare services, how many can we expect? _________
2. JesVic staff is considering chip timing for 2012. Would you be willing to spend an extra $5 on
registration to get your race results more quickly? Y N (Comments welcome on back.)
REQUIRED WAIVER: I understand that a race is a potentially hazardous activity. I know that I should not enter unless
I am medically capable and properly trained. I assumed all risks associated with participating in this event. I release
any and all claims against the event organizers and volunteers, and the town of Watsontown and its employees. I also
permit race organizers to use photos and/or videos of my likeness captured at the JesVic 5K for advertising purposes.
_______________________________________________________________________________
Signature (If under 18, please have guardian sign instead.) Date