Last Name First Name
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Address
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City/State/Zip
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Birth Date Area Code Telephone
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Mo Date Yr
E-Mail Address (optional - for last-minute change information)
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Shirt Size
Adult sm |___| Adult med. |___| Adult Lg |___| Adult XL |___| Adult XXL |___|
WAIVER. Knowingly and at my own risk I do hereby apply to enter an athletic contest. I hereby agree that I release and discharge the 622 Education Foundation, and other parties associated with the 622 Education Foundation, from all claims, demands, injuries, damages, action or causes of action from all acts of active or passive negligence on the part of such corporations, organizations, clubs, their agents or employees, and hereby assume all the risks associated with my participation in the event. Further, I hereby grant full permission to the 622 Education Foundation to use my name and likeness, as well as any photographs and other records of this event in which I may appear, for any legitimate purpose in advertising and promotion of the 622 Education Foundation
Signature______________________________________________________
(by parent or guardian if participant is under 18)
