IF YOU WISH TO BRING FORM FILLED OUT, PLEASE COPY AND PRINT
INDIVIDUAL REGISTRATION-LIABILITY WAIVER FORM
Participant Name __________________________________________________
Address __________________________________________________________
City___________________________ State__________ Zip Code ___________
Phone ________________________ Email ______________________________
Physician Name _______________________________ Phone _______________
Family/Friend _________________________________ Phone _______________
Special Medications and Instructions ____________________________________
___________________________________________________________________
GENERAL RELEASE, WAIVER OF LIABILITY AND PARTICIPATION AGREEMENT
The participant, or guardian for the participant, assumes all risks of participation, allows for all media use of photos without compensation and acknowledges that the entry fee is non-refundable.
SIGNATURE______________________________________________ DATE______________