#

Sponsor's Name

Address

Phone

Donation Check*

Cash

1

2

3

4

5

6

7

8

9

10

Text Box: In consideration of signing this agreement, I hereby for myself, my heirs, and administrators assume any and all risks which might be associated with this event. I waive and release any and all rights for damages which I may have against the organizers and any others connected with this event, their representatives, successors and assigns of any and all injuries or damages of any kind whatsoever suffered by me as a result of taking part in this event and any related activity.

Participant (or Parent/Guardian if under 18 yrs.) _____________________________

Verified___________________