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Lind Calvary Assembly of God
2008 Coaster Car Race Registration Form
Name________________________________
Date of Birth__________ Age_____
Street Address_______________________________
Phone Number___________
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.
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 or ward’s
participation in the
Coaster Car Race.
Signature of
Parent/Guardian__________________________________________________
Street
Address______________________________________________________________
City____________________________________ State___________ Zip
Code___________
Date______________________
Please return by June 12, 2008 to: Lind Calvary Assembly of God
P.O. Box 527
Lind, WA
99341
If you have any questions, please contact: Jim Dworshak at 509-667-0077 |