2016 Raft Race Mechanical Registration

REGISTRATION FORM MECHANICAL

Legal signature of ALL CREW MEMBERS

 

For and in consideration of the privilege of being allowed to participate in the Citrus 95.3/Fox 96.7 Crystal River Raft Race, the undersigned does hereby voluntarily assume the risk of any possible mishap or accident which may occur in connection with said race and does hereby release, hold harmless and forever discharge WXCV and WXOF and all other participating sponsors and associates of the Citrus 95.3 / Fox 96.7 Crystal River Raft Race form and all claims resulting from the use of any photograph, motion picture or interview in which the undersigned are involved, and forego any remuneration for the same.

 

If you are entering a raft, pre-register at Citrus 95.3 / Fox 96.7 studios located at 964 S. Crystal Glen Dr. Lecanto Florida, 34461, or mail your form to the above address. There will be a $25 registration fee the day of the race. For more information contact (352)746-9596.

 

CAPTAIN_____________________________________Date___________

 

CREW______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Name of Raft __________________________________________________

 

Phone Number _________________________________________________

 

** If under the age (18 years old), the crew member must obtain the signature of the legal guardian or parent. ** The undersigned, as a parent or guardian of a minor, do hereby approve and consent to the forgoing release.