NAME_____________________________________ *Race will take place rain or shine

ADDRESS_________________________________

AGE________________ M________ F________

PHONE__________________________________

Waiver/Consent

I hereby, for myself, my child, my heirs, executors and administrators, waive and release any and all rights and claims for damages I or my child may have against Fossil Country Museum or on behalf of any organization in whose building or grounds this activity is being held, and any instructors, directors, or persons of these organizations from any liability or injuries received or loss to person or property while participating in any activity sponsored by Fossil Country Museum. I understand that as a participant, I am not covered by Fossil Country Museum insurance while traveling to or participating in this activity. If the participant is a minor, I give my permission for his/her participation in this activity and for the instructors/supervisors to act on my behalf in case of a medical emergency.

Signature________________________________ Date__________________

Parent Signature _____________________________ (parent or guardian if under 18)