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Saturday, June 24, 2000 -- Rices Landing, PA
4th Annual Rices Landing Riverfest

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Name:_______________________________   MALE____  FEMALE____ 

Address:____________________________  AGE (on June 26):____

City:______________________  State:____  Phone #___________

Waiver: In consideration of the acceptance of this entry, I waive for myself, my heirs, and assigns, all claims for damages which I might have against the race, it's sponsors (Rices Landing Fire Department) or any other organization, business, or individual as a result of any and all injuries which might be received during the race.

Signature: _____________________________________________
(parent's signature if under 18)