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Please PRINT this form and send in to address listed below. IN CONSIDERATION FOR ALLOWING ME TO PARTICIPATE IN THE 'CHIEF WORUMBO'S ANDROSCOGGIN FUN RIVER RACE' ON SUNDAY JULY 13, 2008, IHEREBY WAIVE ANY LIABILITY THAT THE SPONSORS OR VOLUNTEERS MAY HAVE TO ME ARISING OUT OF MY PARTICIPATION IN THE RACE. FURTHERMORE, I WARRANT THAT I HAVE READ THE RULES AND REGULATIONS FOR THE RACE AND I HEREBY AGREE TO HOLD HARMLESS THE DRS. BIANCHI AND TRIGGIANI, THE MILLER HYDRO GROUP, THE WORUMBO MILL OUTLET STORE AND FPL ENERGY MAINE HYDRO AND ALL VOLUNTEERS FOR ANY PHYSICAL, PERSONAL OR PROPERTY DAMAGE WHICH MAY OCCURE TO ME, MY EQUIPMENT OR PROPERTY,IN RELATION TO MY PARTICIPATION IN THE RACE. I AM AWARE THAT PARTICIPATION IN THIS RACE MAY PRESENT A SERIOUS STRAIN ON MY BODY, OR ITS PARTS, AND FURTHER WARRANT TO THE SPONSORS THAT I AM IN PRPOER PHYSICAL CONDITION FOR PARTICIPATION IN THE RACE. ALL ENTRANTS MUST COMPLETE AND INDIVIDUALLY SIGN AND DATE A DISCLAIMER OF LIABILITY. PARENT / LEGAL GUARDIANS MUST SIGN THE DISCLAIMER IF PARTICIPANT IS UNDER THE AGE OF 18. ************************************************************************************ ALL PADDLERS AND PASSENGERS MUST WEAR A USCG APPROVED PDF. *********************************************************************************** PLEASE SIGN SIGNATURE AND PRINT INFO CLEARLY (IF MORE THAN (2) PADDLERS, LIST ADDITIONAL ON SIDE OF FORM PLUS EXTRA LUNCH AND "T's") RACE CATEGORIES: Go HERE FOR RACE CATEGORY INFO. RACE CATEGORY __________________________________________ PARTICIPANT SIGNATURE(S) #1_____________________________ #2_______________________________ PARTICIPANT NAME(S) #1___________________________ #2_____________________________ TOWN/STATE #1_______________________________ #2__________________________________ AGE/SEX/PHONE #1____/____/__________________ #2____/_____/___________________ FMI: FAYE @ 207-353-2728 (W) -5771(H) 0R E-MAIL bfayeray@aol.com |
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