2019 Colorama Outhouse Race Entry Form

Team Name: _____________

Address: _____________

Phone: _____________

Team Member Names Age Phone Number

Captain 1.

2.

3.

4.

RELEASE & WAIVER OF LIABILITY AGREEMENT: I know that participating in the Outhouse Race event is a potentially hazardous activity. I know that I should not enter such an event unless I am properly fit, trained, and medically able. I am aware of the risks of the Outhouse Race competition, and I assume those risks. I am also aware of and assume any and all other risks, foreseen and unforeseen, including, the effects of weather, the condition of the racecourse, and the increased chance of injury due to activity of this nature.

Knowing these facts, and in consideration of your accepting my entry to participate in the Outhouse Race competition, I hereby, for myself, my heirs, personal representatives, and anyone else who may claim on my behalf, promise not to sue, and waive, release and discharge the Bull Shoals Lake/White River Area Chamber of Commerce and the City of Bull Shoals, and all Sponsors, and Directors, and Officials, and Volunteers helping with the "Outhouse Race" contest, from any and all damage of every kind foreseen and unforeseen, arising out of or in the course of my participation in this event.

The Bull Shoals Lake/White River Area Chamber of Commerce reserves the right to use photos and video of participants and/or any entries for future publicity at no monetary compensation.

The undersigned team members agree to all provisions of the attached Release & Waiver of Liability Agreement, and assume all risks associated with the participation in the 2019 Bull Shoals Lake/White River Area Chamber of Commerce, Colorama Outhouse Races.

Team Name:

Participant Names (print) Signature

1. Date:

2. Date:

3. Date:

4. Date: