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Great Race Form 2012

 

THE GREAT RACE  AND RELEASE AND INDEMNITY FORMS

Old Settlers 2011 HalsteadKansas.com

DUE BEFORE AUGUST 1, 2012

Send or give to:

Phil Adams, 502 North St., Halstead, KS 67056

 

Team Name_____________________________________________________

 

Contact Person______________________________________________

 

Address____________________________________________________

 

Phone Number of Contact Person_______________________________

 

Means of Team ID___________________________________________

(Shirt, vest or whatever & color)

 

T-SHIRT ORDERS - $9 EACH, larger sizes are $2 higher

 

COLORS - Please circle your color choice

 

BURGUNDY HEATHER GRAY RASPBERRY

 

PINK NEON PINK ORANGE

 

LAVENDER RED GREEN

 

NEON GREEN JADE GREEN PURPLE

 

TURQUOISE LIGHT BLUE NAVY BLUE

 

WHITE YELLOW TAN

 

COLOR NOT HERE, ASK AND WE’LL SEE IF THEY CAN GET IT!

 

Number of each size: SM_____ MED_____ LG_____ XL_____

 

2XL_____ 3XL Children’s sizes also available

 

Entry fee ___________$45

Total for shirts_________________

 

Please make copies and have each participant sign one and return to us by race time.

 

 

RELEASE AND INDEMNITY

 

I hereby, for myself, my heirs, executors and administrators, forever release, discharge and hold harmless, the City of Halstead, members of the Great Race Committee and all others interested parties, from any and all rights, claims, demand, liabilities and actions whatsoever that may accrue to me, or any person sponsored by me, as a result of any and all injuries or death sustained by me and/or loss or damage of equipment or property during The Great Race to be held August 10th, 2012 at or near Halstead, Kansas.

 

Date_________________________

 

 

Signature____________________________________________________

 

 

 

Minor’ Parent/Guardian_______________________________________

 

 

 

Witness­_____________________________________________________

 

 

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