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| Kevin T. Szocik Memorial Gate P.O. Box 11 Lunenburg, MA 01462 [email protected] |
| Waiver and Release of Liability I ____________________, a voluntary participant in the walk sponsored by the Kevin T. Szocik Memorial Gate Committee agree to release and hold harmless the Town of Lunenburg, and their employees, agents, students, and other persons participating, for any and all claims, demands, rights, and causes of action of whatsoever kind and nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, resulting, and to result, from participating in the walk sponsored by the Kevin T. Szocik Memorial Gate Committee. I/We have read the foregoing release and fully understand it. Signature __________________________ Parent (if under 18) __________________ |
| Register - $15 per person: One form per person, photocopies accepted. Name: ____________________________ Last First Street: _____________________________ Town: ____________State:____Zip:_____ Male ____ Female _____ Circle shirt size Adult: XXL XL L M S Child: 6-8 10-12 14-16 |
| I would like to make an additional tax deductible donation of $______________ |
| I cannot attend but I would like to donate $______________ to Kevin's Gate. |
| Print out and send to the address below |
| ___________________________________________ |
| ___________________________________________ |
| Registration Form |
| Kevin's Gate Memorial Walk |
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