Parent    Guardian Waiver Form

If applicant is a minor (less than 18 years old), then this document must be
signed by parent/guardian and minor.  Form must be submitted and also printed and signed by parent/guardian and minor.  Printed and signed form must be mailed to:

Holly Dionne

26 Newton Ave  

Caribou, ME 04736

Form must be received by committee before January 5, 2018.

I also hereby certify that I am the parent or legal guardian of this minor.

I will take full responsibility and indemnify EAGLE LAKE RACE COMMITTEE OR EAGLE LAKE CHAMBER OF COMMERCE for any unforeseen events that may cause harm to this underage participant.

 

Please complete the form below

Name of Parent/Guardian *
Name of Parent/Guardian
Name of Minor Participating *
Name of Minor Participating