Yacolt Kids Car Show Registration Form
Date: 08/17/2024
Car Owner Name
First Name
Last Name
Parent's Name
First Name
Last Name
Car Owner PARENTS Phone Number
Please enter a valid phone number.
Car Owner PARENTS Email
example@example.com
Car Owner PARENTS Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization (please click)
Authorization and Release: As the undersigned, am the parent/legal guardian of the above-named child. By signing this form, I grant permission for my child to participate in the Yacolt Kids Car Show organized by Desiree Lorentz, Impact Automotive and hosted in the Town of Yacolt. I acknowledge and agree to the following terms and conditions: Assumption of Risk and Release of Liability: I understand that participation in the Yacolt Kids Car Show involves inherent risks and hazards. I, on behalf of my child and myself, hereby release and hold harmless Desiree Lorentz, Impact Automotive, and the Town of Yacolt, including their officers, employees, volunteers, and agents, from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or harm of any kind that may result from my child’s participation in this event. Medical Authorization: In the event of an emergency, I authorize the organizers of the Yacolt Kids Car Show to obtain any necessary medical treatment for my child. I agree to be responsible for any medical expenses incurred. Photography and Media Release: I grant permission for my child to be photographed and/or recorded during the Yacolt Kids Car Show. I further authorize the use of these photographs and/or recordings on social media, promotional materials, and other media platforms by Desiree Lorentz and Impact Automotive. I understand that these images and recordings may be used without further notification or compensation. By signing below, I acknowledge that I have read, understood, and agree to the terms and conditions outlined above.
Car Owner Parent's Signature
Date Signed
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Month
-
Day
Year
Date
Submit
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