KIWANIS CRAZY KICKER,
SATURDAY, OCTOBER 15, 2011
REGISTRATION FORM
EARLY REGISTRATION (POSTMARKED BY OCT 10TH) $25.00
LATE
REGISTRATION
$35.00
FAMILIES OR GROUPS OF 4 OR
MORE
$20.00 PER RIDER
MUST BE PAID WITH ONE CHECK PRIOR TO OCT. 11th
PO BOX 836
MINERAL WELLS, TEXAS 76068
NOTICE: THIS ENTRY BLANK AND RELEASE FORM IS A CONTRACT WITH LEGAL CONSEQUENCES, READ IT CAREFULLY BEFORE SIGNING.
In consideration of
acceptance of my entry, I, the undersigned, assume full and complete
responsibility for any injury or accident
which may occur to me during the Kiwanis Crazy Kicker Ride oar while I
am on the premises of the event. On
behalf of myself, my heirs, executors, and assigns, I release and hold harmless
the sponsors, promoters and all other persons and entities associated with a
this event from any and all injury and damages sustained by me whether such
injury or damages are caused by negligence of the sponsors, promoters, or other
person and entities associated with the event or otherwise I acknowledge that I
am familiar with the dangers involved in competing in this event, that there
may be holes in the riding surface or other permanent or temporary obstacles
which I must be careful to avoid and I agree to familiarize myself with the
course prior to the commencement of the event.
I understand that the event takes place on public streets and roads with
vehicular traffic. I certify that I am
in good physical condition and am fully able to participate in this event. I also grant full permission to any and all
sponsors to use photography and records of this event for any purpose. I have read and understand all of the above.
Participant’s
Signature_____________________________________________Date___________________
Parent or Legal Guardian
Signature__________________________________Date___________________