18 and over entry form

REGINA’S ANNUAL SKATEBOARD COMPETITION
ENTRY FEE:
$20.00
DO NOT FILL IN THIS AREA
NAME
CATEGORY
PAID
18 AND OVER ENTRY FORM
NAME: ________________________________________________________________________________
ADDRESS: _______________________________________________________________________________
CITY: ____________________________________________________________________________________
PHONE: _________________________________________________________________________________
AGE: ___________________________HOSPITALIZATION #:_______________________________________
RELEASE AND WAIVER OF CLAIM
I, ______________________________ , being 18 years of age or older, hereby acknowledge and agree in consideration of
being permitted to participate in the Welcome to Winter 15 skateboard contest offered by: The City of Regina, The Tiki Room and
Regina Exhibition Association Limited
1. I do hereby and forever release and hold harmless from liability the City of Regina, The Tiki Room, SK8 Regina, all event
sponsors and Regina Exhibition Association Limited as offerer of the Welcome to Winter 15 contest, and any employees, agents,
or officers thereof of the City of Regina, the Tiki Room, SK8 Regina, any event sposnors and Regina Exhibition Association
Limited from any property loss or personal injury claims that I may have as a result of being involved in the said program;
2. I acknowledge that the City of Regina, the Tiki Room, SK8 Regina, the event sponsors and Regina Exhibition Association
Limited is not warranting my safety while participating;
3. I have carefully read and understand clearly that by signing this Release and Waiver of Claim, I will be forever prevented from
suing or claiming against the City of Regina, the Tiki Room, SK8 Regina, any event sponsors and Regina Exhibition Association
Limited or any employees, agents, or officer thereof for any property loss or personal injury I may suffer while participating;
4. I also acknowledge that the City of Regina, the Tiki Room, SK8 Regina and Regina Exhibition Association would not permit
myself to participate unless I signed this Release and Waiver of Claim and agreed to comply with the rules and regulations set
out by the City of Regina, the Tiki Room, SK8 Regina, any event sponsors and Regina Exhibition Association Limited.
Signed this ____ day of ____________________________, 20_____
_____________________________
Signature
________________________________
Witness
___________________________________________
name of parent or legal guardian (please print legibly)
telephone:______________________
work
____________________
residence
WELCOME TO WINTER IS ALSO BROUGHT TO YOU BY: