2008 SKATE COMPETITION ENTRY FORM
One contestant per form. You may duplicate this form.
Parent/Guardian Information: (Please Print) | ||||||||
Last Name: | First Name: | MI: | ||||||
Mailing Address: | ||||||||
City: | State: | Zip: | ||||||
Home Phone: | Work Phone: | |||||||
Emergency Contact Information: (Please Print) | ||||||||
Emergency Contact Name: | ||||||||
Emergency Contact Phone: | Relation: | |||||||
PARTICIPANT INFORMATION: (Please Print) | ||||||||
Participant Name: | Age: | |||||||
2008 SKATE COMP. | Skill Level: | Date: | Fee: | |||||
| 5/17/08 | $5.00 | ||||||
| TOTAL: | |||||||
In consideration of the acceptance of my application by the Oregon City Optimist Club and the Oregon City School District for entry into the above event, the undersigned applicant herby agrees to indemnify and hold the Oregon City Optimist Club, Oregon City School District, Skate Legion and all officers, agents, employees and/or volunteers of the above groups (the “indemnities”) harmless from:
1. All liability, damage, loss, cost or expense, including but not limited to attorney’s fees, that the indemnities may sustain or incur on the account of any damage to or destruction of any property that the Oregon City School District, Oregon City optimist Club and Skate Legion may own or in which they may have interest;
2. All liability, damage, loss, cost or expense, including but not limited to attorney’s fees, on account of any damage to or destruction of any property belonging to any person, firm, or corporation; and
3. All liability, damage, loss, cot or expense, including but not limited to attorney’s fees, on account of any damage resulting from injury or death of any person or persons resulting from or in any way connected with the participation by the applicant’s child and or the applicant, it’s agents or employees in the above event.
I agree that the Oregon City Optimist Club and the Oregon City School District #62 are not liable for any medical, dental or hospital bills that may occur as a result of injuries incurred while participating in a supervised activity and that such bill in the excess of insurance benefits shall be the responsibility of the participant’s parents or guardian. In addition the participant agrees to follow the rules and the guidelines of the Oregon City School District. Participant agrees to conduct him/her self in an appropriate manner. If all rules and regulations are not followed the Event Coordinator has the right to ask, and expect, participant to leave the premises immediately with out a refund.
Participant Signature:___________________ Date:_______
Parent/Gaurdian:______________________ Date:_______
OFFICE USE ONL
| CASH | CHECK | RECIEPT # | DATE |
Please return this form with payment to: the Pioneer Family Festival, 1016 Monroe Street, Oregon City, OR 97045 or to Skate Legion, 15043 SE Mc Loughlin Blvd. Milwaukie, OR. Contestants may register the morning of the event, starting at 10:00 a.m. at the Oregon City Skate Park within Clackamette Park in Oregon City. Call (503) 679-4464 with any questions. Contestants who register the day of the event need to make sure they have a parent or guardian signature. Forms not signed upon arrival will require a parent or guardian signature in person at the event site. Participants may be required to wear helmets.