Waiver & Release FORM
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REGARDS:
East Coast Tracking Club___________________________________________________________________________ |
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Date Arrive
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Date Depart
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Name (Last, First, Middle Initial)
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Nickname
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Home Address (Number, Street)
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City
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State/Province
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Zip
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Country
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Date of Birth
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Age
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Home Phone
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Business Phone
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___ Male
___ Female |
___ Single
___ Married |
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Occupation/Employer
_______________________________________________________________________________________________________________________ |
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Emergency Contact
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Phone
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Relationship
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How did you learn about Indigo Acres?
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Health/Special Diet Information
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Signature of Participant
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Date
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