Last Updated: March 27, 2017
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Color Me Crazy 5 KICM Team Registration

KICM PARTICIPANT INFORMATION
* First Name:
* Last Name:
* City:
* State:
* Best Contact Phone:
* Email:
* Gender:
* Shirt Size:
* Age range:

PARENT/GUARDIAN #1 (If under 18)
Firstname:
Lastname:
EMail:
Cell Phone:

PARENT/GUARDIAN #2 (If under 18)
Firstname:
Lastname:
Email:
Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION
* Emergency Contact:
* Phone:
Relationship to Participant:

WAIVER INFORMATION
ADULTS: I hereby request that I be allowed to participate in the Color Me Crazy 5 Fundraiser and understand that I will not be allowed to participate if this form is not completed and/or is altered in any way.
I also agree to waive any claims of liability against the City and any and all officers, agents and employees of the City, against all damages, including but not limited to, any loss, liability, expense, suit, or claim for injury to persons or damages to property arising out of the activities of City or its agents during the described activity, whether or not any act or omission complained of is authorized, allowed or prohibited by City and all reasonable expenses together with all damages and penalties thereto. By allowing participation in Color Me Crazy 5, City and its “employees,” as defined by the Governmental Tort Claims Act, 51 Okla. Stat. § 151 et seq., do not waive sovereign immunity, any defenses, or any limitations of liability as may be provided for by law.

MINORS: I, the parent or legal guardian, hereby grant my permission for my child to participate in the H.F.V. Wilson Color Me Crazy 5 Fundraiser and understand that he or she will not be allowed to participate if this form is not completed and/or is altered in any way.
I also agree to waive any claims of liability against the City and any and all officers, agents and employees of the City, against all damages, including but not limited to, any loss, liability, expense, suit, or claim for injury to persons or damages to property arising out of the activities of City or its agents during the described activity, whether or not any act or omission complained of is authorized, allowed or prohibited by City and all reasonable expenses together with all damages and penalties thereto. By allowing participation in Color Me Crazy 4, City and its “employees,” as defined by the Governmental Tort Claims Act, 51 Okla. Stat. § 151 et seq., do not waive sovereign immunity, any defenses, or any limitations of liability as may be provided for by law.
By selecting "I agree" below, I hereby certify that I have the legal authority to grant permission for the above named minor child to participate in Color Me Crazy 4.

Rain or Shine Policy: Color Me Crazy 5 will be held rain or shine! No refunds will be given.

Photograph/Video Authorization: I authorize the HFV Wilson Community Center/City of Ardmore, including its staff and volunteers, to photograph/record my/my child’s image during sponsored activities and events. I also permit the HFV Wilson Community Center/City of Ardmore to use the photographs/video for various purposes including, but not limited to, the HFV Wilson Community Center/City of Ardmore websites, brochures, flyers, television, newspaper/magazine articles and advertisements. I agree to release and hold harmless the HFV Wilson Community Center/City of Ardmore, its staff and volunteers from any liability related to the making or use of these photographs/recordings for the purposes stated above.
I/we agree with the above   *

* required


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Payments Accepted By

Note: Credit Card information can be entered once this form is submitted