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|
Lind Calvary Assembly of God 2013 Coaster Car Race Registration Form |
| Name_____________________________________________ Date of Birth______________________ Age________ Phone _________________ Street Address_______________________________________________ City _______________________ State ________ Zip Code _______________ I, ______________________________________________, hereby agree to the following: ~helmet required ~enclosed car body ~12" maximum diameter wheels ~be able to come to a full stop within 30 feet |
| Signature of Racer______________________________________________ | Date ____________________ |
| I,
_______________________________________________(parent/guardian), grant
permission for my son/daughter/ward to enter the
Lind Calvary Assembly of God Coaster Car Race
on June 9, 2013 at 2:00 p.m.
I hereby waive and release any and all claims, rights, causes of action,
demands or otherwise, whether for personal injuries, property damage, or
any other loss, damages or expenses which I, as a parent/guardian,
and/or my son/daughter/ward may have against Lind Calvary Assembly of
God and/or its sponsors, agents, employees, full or part-time, or
associates of any status whatsoever, arising from or in any manner
related to my son's/daughter's/ward's participation in the Coaster Car Race. Signature of Parent/Guardian__________________________________________ Street/Mailing Address _______________________________________________ City________________________________State_______Zip Code_____________ Date _____________________________ |
Please return by June 7, 2013 to: Lind Calvary Assembly of God, PO Box 527, Lind, WA 99341-0527 If you have any questions, please contact: Brad Marcus at 509-887-2304 |
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