We/I request the Carlisle Old Home Day Association, Inc., to permit the undersigned adult, or our son/daughter to enter the soap box derby to be held in Carlisle, MA. on Church Street on or about June 27th, 2009. We/I have inspected the course on which the derby will run and the rules which govern the event. We have determined that the Association has selected a course and prescribed safety regulations that will provide adequate safety for the participants. We are (I am) responsible for the condition and safety related aspects associated with our (my) soapbax racer.
Accordingly, we/I fully indemnify and hold harmless the Old Home Day committee and the Town of Carlisle from any and all liability or damage to (me) our son/daughter and my/(our) soapbox racer or any damage that the operation of our my/(our) racer may incidently be responsible for as a condition of (my) his/her entry into the event.
Dated this 27th day of June, 2009
Participant printed name and signature
Father’s printed name and signature
Mother’s printed name and signature