DRIVER APPLICATION

Waiver of Liability

In consideration of being permitted to participate in the Fish Box Derby, I the undersigned, in full recognition of the dangers inherent in such activities, do hereby waive, discharge, release, and forever discharge the Fish Box Derby, Inc., its committee, its officers, members and volunteers, from and against all claims, demands, actions or causes of action for costs, expenses or damages to personal property or personal injury or death which may result from participation in these activities.

I understand and admit that my participation and my child's participation in the Fish Box Derby are voluntary. I assume full responsibility for any injury or damages resulting from our participation. I recognize that participation may be hazardous, that our participation is at our own risk, and that is my responsibility to exercise reasonable judgment.

DRIVERS NAME *
ADDRESS *
CITY *
STATE *
ZIP CODE *
TELEPHONE OR CELL NUMBER *
EMAIL ADDRESS *
E-mail Address: *
AGE *
PROOF OF AGE- BIRTH CERT. OR BAPTISMAL CERT.	YES NO
SPONSOR
I HAVE READ THE WAIVER OF LIABILITY AND AGREE THAT IT IS LEGALLY BINDING ON MY HEIRS, EXECUTORS, ADMINISTRATORS, ASSIGNS AND ON MYSELF. *
I HAVE READ AND UNDERSTAND THE OFFICIAL RULES. *
SIGNED THIS DAY OF *
PARENT OR GUARDIAN *
WITNESS *
PREFERRED CAR NUMBER. (do not write same as last year) *
Verification Code:
Enter Verification Code: *
* Required