Overbrook Kids Pond Second Annual Fishing Derby September 11, 2010 (Ages 16 and under) Registration Form

Turn in to schools or at Overbrook City Hall by Wednesday Sept 8^th 2010. All participants must sign-in the day of the event.

You can also register the morning of the event from 8:30 to 9AM

Participants Name__________________________________________ Age ______

Parents Name_______________________________________________________

Address________________________ City________________ST_____Zip_______

Email _________________________ Telephone ___________________________

Emergency Contact _________________ Emergency Telephone ______________

City of Overbrook

Release of all Claims

RELEASE made_______________, 20__ by ________________________________

(Parent/Guardian)

For _______________________________________________________________

(name of child)

I grant permission for my child to participate in the Overbrook Kids Pond Fishing Derby on September 11, 2010. I hereby release the City of Overbrook, its agents and employees from all actions, causes of action, damages, claims or demands which I, my heirs, executors, administrators or assigns may have against the City of Overbrook, and other above described parties, for all personal injuries known or unknown which _______________________________________ has or may incur by participating in the above described activity.

I, the undersigned, have read this Release and understand all its terms, and I execute it voluntarily and with full knowledge of it significance.

_____________________________________

Parent/Guardian Date