Maple Syrup Stampede

REGISTRATION FORM

Name: ___________________________

Sex: Male__Female__ Age: ____ (of those 13 yrs & under as of Dec. 31/07)

Address:________________________________________________________________

Telephone No.___________________Skate:__________Classic:________

ATHELETES RELEASE

I enclose $____for entry in the Maple Syrup Stampede. Money Orders & Cheques should be made payable to “Jocelyn Recreation Committee” and sent to: R.R #1, Hilton Beach, ON POR IGO.

Entry Fee: $20.00 before Jan.11/08 $25.00 from Jan. 12 – Feb.6/08 $35.00 Feb. 7 - 9/08

No refunds except in the case of the event being cancelled & then $2.00 entry fee will be retained for a administrations costs.

Waiver: I, the undersigned know that skiing is an action sport and carries significant risks of personal injury. I know that there are natural and manmade obstacles and hazards, surface and environmental conditions and risks in combination with my actions can cause me very severe and occasionally fatal injury. I agree that I am totally responsible for my own safety while I participate in this event and will not hold the Township of Jocelyn, Jocelyn Recreation Committee or property owners responsible for any injuries sustained in this event.

Signature:____________________________________________ Date:_____________________

*Parental signature required for entrants under 18 years of age.