YES House Foundation | Amazing Inflatable Costume

Relay Team or Individual Registration:

Contact Phone:

Email:

Address:

Relay Team name:

Age Category:

13-15

15-17

18-54

55+

Age

Date of Birth

Male

Female

Parent or guardian if under 18:

Fun facts about the racer/team:

Are you renting an inflatable T-Rex Costume? ($50 rental fee)

Yes

No

Race Waver: I, individually, (and or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge Youth Emergency Services Foundation, Gillette, WY, and any and all other supporting groups of this said racing event, together with all their officers, agents, officials and employee, from any and all liability, claims, demands, actions, or causes of actions whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event. I further state I am in proper physical condition to participate in this event, in addition, I agree that my participation in this event requires that I will not participate with roller blades, skateboards, or anything the race director deems dangerous to myself or other participants and that the race director may remove me from this event for a violation of said polity. I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, video, motion picture, recordings, and any other record of this event for any purpose. I also agree that the entry fees are non-refundable, and that this entry is non-transferable. Thank you for participating.

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