2011 Cullen Ferreira White Christmas Invitational
December 25-27, 2011
PLEASE PRINT INFORMATION
Racers Full Name ________________ Address ________________________
Town/St/Zip_____________________ W-Phone: _______________________
H-Phone: _______________________ C-Phone: _______________________
E-Mail: ________________________
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Male ____ Female _____ Current Age ____ Birthdate __________
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In the event of an emergency and nobody can be reached at the above phone numbers, we are to notify:
Name: ____________________ Phone __________________ Relationship ________________
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In the event of an emergency requiring medical attention, I authorize that necessary medical attention be given to my child by a qualified physician in the event I cannot be reached.
Signed ___________________________Parent/Guardian __________________________
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RELEASE AND INDEMNIFICATION AGREEMENT: Please read carefully and sign below.
The undersigned, being the legal guardian of the participant or the participant if 18 or older, in consideration of the agreement by the Town of Westford, MA and Danny Ferreira, LLC to allow me to participate in the 2011 Cullen Ferreira White Christmas Invitational, hereby agrees as follows:
1. That no claim will be made by the undersigned on behalf of the participant for personal injuries of other losses sustained by the participant as a result of the participation in the 2011 Cullen Ferreira White Christmas Invitational.
2. That in the event any claim is made by the participant for injuries or damages sustained as a result of participation in the 2011 Cullen Ferreira White Christmas Invitational, I shall hold the Town of Westford, MA, Danny Ferreira, LLC, or Santa, Chris Cringle, St. Nick or any other aliases and all their agents, principals, employees and elves harmless from, and indemnify them against, any such claims, including reasonable attorneys' fees incurred in connection therewith, whether or not such claims result in litigation. The undersigned acknowledges that participation in the 2011 Cullen Ferreira White Christmas Invitational may reasonably be considered a dangerous activity. This agreement is executed by the undersigned upon the understanding that the Town of Westford
Parent/Legal Guardian/ Participant Signature: ___________________ Date: _____________
