BUCKEYE WOODCARVERS ROUNDUP

In consideration of my acceptance as participant in the Woodcarving Classes, I do hereby, my heirs, executors, and administrators voluntarily assume all risks whether foreseen or unforeseen and waive, release and forever discharge any and all rights and claims for damage which I have or which may arise to me against BUCKEYE WOODCARVERS ROUNDUP or POOR FARMER'S CAMPGROUND, and volunteer helpers for any and all damages to persons or property which may be sustained or suffered by me regardless of negligence in connection with my said association with, or entry into, said class and arising out of my traveling to, participation in, and return from class. (If participant is under 18 years of age, their guardian or parent has to sign for them.)

I further state that I understand this release form and have signed this document voluntarily this___________day of_____________________.

SIGNATURE______________________________________________________________________________

PRINT NAME_________________________________________________________________________________

RELATIONSHIP (IF under 18 years of age)

__________________________________________________________

ADDRESS________________________________________________________________________________

CITY, STATE, & ZIP___________________________________________________________________________

TELEPHONE NUMBER________________________________________________________________________

E-MAIL ADDRESS___________________________________________________________________________

IN CASE OF EMERGENCY CONTACT (NAME, ADDRESS, PHONE,RELATIONSHIP)___________________________________________________

________________________________________________________________________________________________________________

IF YOU NEED A HANDICAP SPOT FOR YOUR CAMPER OR JUST YOUR CAR PLEASE CHECK HERE________AND EXPLAIN ON BACK WHAT EXACTLY YOU NEED

MAIL to: BUCKEYE WOODCARVERS ROUNDUP with PRE-REGISTRATION FEE ($20.00 PER PERSON) BEFORE JUNE 30, 2023 to: JIM FOSTER, 306 GLENWOOD AVE, PIQUA, OH 45356

IF YOU HAVE ANY SPECIAL REQUESTS PLEASE LET US KNOW ON THE BACK OF THIS APPLICATION,