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Downtown Frankfort Triple Crown
Participant registration Form
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1.
Participant Name
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2.
Date of Birth
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3.
Phone Number
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4.
email
5.
Are you part of a team? If so, what is your team name?
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6.
Event(s) you will be competing in:
(Required.)
Pedal for the Posies
Bounce for the Roses
Rebecca Ruth Challenge
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7.
Emergency Contact: Please list name, phone number and relationship.
8.
Please describe any medical conditions or special needs of which staff will need to be aware
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9.
Consent Statements
(Required.)
In case of an accident or injury, I authorize treatment by a medical professional and/or to be given the necessary emergency medical care by trained staff.
I give my consent to participate in any and all programs and activities sponsored or provided by the …DFI, and do hereby waive, release, absolve, forever discharge, and agree to hold harmless the organizers, supervisors, participants, and persons involved in the operation, organization, sponsorship, supervision or participation of these activities and programs, including without limitation, the Downtown Frankfort, Inc., and all their respective trustees, directors, members, officers, employees, representatives, agents, sponsors, successors, for, from, and against any claim or cause of action of any nature whatsoever that may be available to the Participant, arising out of any injury, accident or illness to the Participant, arising in any way out of or in connection with the Participant’s participation in such programs and activities.
I give my consent to be photographed or filmed for the purpose of documentation and marketing of the Downtown Derby Celebration. I understand that the images will not be bought or sold for commercial purposes; that the Downtown Derby Celebration, not the individuals, will be identified by name with the relevant photograph(s).