South Whitley Fall Festival Donut Run Legend Name * Address * City * State * Zip T-Shirt Size * E-mail Home/Cell Phone * In case of emergency, contact: Name * Phone * $ 20.00 per participant: Cash/Checks made payable to: South Whitley Parks Department Mail Payment to: PO Box 463, South Whitley, IN 46787 BOTTOM PORTION MUST BE SIGNED AND DATED BY PARENT OR LEGAL GUARDIAN IF PARTICIPANT IS UNDER THE AGE OF 18. I, the undersigned parent/guardian, do hereby grant permission for my son/daughter, named above, to participate in the donut run. In order that my child may receive the proper medical treatment in the event that he/she may sustain injury or illness during the South Whitley Fall Festival Donut Run, I hereby authorize those in charge of the event to obtain or provide medical treatment for my child for such injury or illness during the race, and I hereby hold those in charge of the event and the sponsoring organization, as well as its representatives, harmless in the exercise of this authority. I further understand that there is always a possibility that my child may sustain physical illness or injury while at the donut run. If this occurs, I hereby authorize the individuals in charge of the race and representatives to refer my child to a medical treatment center (hospital, etc.). I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my son/daughter for physical illness or injury that he/she may sustain during the donut run. Understanding that there is always a possibility that my child may sustain physical illness or injury, I acknowledge and understand that my child is assuming the risk of such physical illness or injury by his/ her participation, and I further release the sponsoring organization and its representatives from any claims for personal illness or injury that my child may sustain during the donut run. I further acknowledge and understand that my child will be responsible for his/her failure to abide by the rules and regulations of the donut run. Name of Parent or Guardian (if participant is under 18 years of age) (Counts as digital signature):
Blacktop Basketball Tournament Date: September 15, 2018 Location: South Whitley Town Park Basketball Courts Rain Venue: Whitko Jr/Sr High School Cost: $20.00 per team Divisions: 4th & 5th Grade 6th – 8th Grade Open Division Registration 8:30-915 am Mail registration to P.O. Box on form or fill out below. Mail payment to P.O. Box of pay on site with cash Sponsored By: South Whitley Parks and Recreation & Whitko Boys Basketball Registration Team Name * *Each Member must complete a registration form, only one waiver is needed per team with all participants parent/guardian signatures Name * Address * City State * Zip * Age * Last Grade Completed * gender MaleFemale Contact Information Email * Guardian(s) name Home/Cell phone Work phone In Case of Emergency Contact Name Phone Name Phone Special concerns (Allergies, medications, etc) Confirmation $ Team Cost: $20.00 Cash/Checks made payable to: South Whitley Parks and Recreation *Money and registration can be mailed to PO Box 476, South Whitley, IN 46787 I, the undersigned parent/guardian, do hereby grant permission for my son/daughter, named above, to participate in the fall festival blacktop basketball tournament. In order that my child may receive the proper medical treatment in the event that he/she may sustain injury or illness during the Blacktop Basketball Tournament, I hereby authorize the league staff to obtain or provide medical treatment for my child for such injury or illness during the tournament, and I hereby hold the South Whitley Parks and Recreation or Whitko Boys Basketball staff and sponsoring organization, as well as its representatives, harmless in the exercise of this authority. I further understand that there is always a possibility that my child may sustain physical illness or injury while at the league. If this occurs, I hereby authorize the tournament staff and representatives to refer my child to a medical treatment center (hospital, etc.). I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my son/daughter for physical illness or injury that he/she may sustain during the tournament. Understanding there is always a possibility that my child may sustain physical illness or injury, I acknowledge and understand that my child is assuming the risk of such physical illness or injury by his/her participation, and I further release the sponsoring organization and its representatives from any claims for personal illness or injury that my child may sustain during the tournament. I further acknowledge and understand that my child will be responsible for his/her failure to abide by the rules and regulations of the tournament. Name of Parent or Guardian (Counts as digital signature)
