Grilling at Madison's riverfront
gazebo on Saturday, August 21th from 9:00am - 11:00am
Contact Information | |
| Child's Name | |
| Parent/Guardian's Name | |
| Parent's Address | |
| City ST ZIP Code | |
| Home Phone | |
| Cell Phone | |
| E-Mail Address | |
Age Group I need to use one of the Kidz Q grills ___ yes ___ no | |
| ___ Ages 8 - 11 | |
| ___ Ages 12 - 15 | |
Agreement and Signature of Parent |
| By
submitting this application, I affirm that the facts set forth in it
are true and complete. I understand that if the child listed above is
accepted as a participant, any false statements, omissions, or other
misrepresentations made by me on this application may result in his/her
immediate dismissal. Waiver of Liability: In consideration of accepting this entry. I, the undersigned, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages against the Madison RibberFest, and their agents, successors, and assignee, for any and all injuries suffered in this event. Further, I hereby grant full permission to the Madison RibberFest and/or agents authorized by them, to use any photographs, videotapes, motion pictures, recordings and any other record of this event for any legitimate purpose. |
| Name of Guardian (printed) |
| Signature |
| Entrance fee of $10
paid: |