BIRINGER FARM & CRYSTAL LODGE #122, F & AM of WA

STRAWBERRY SHORTCAKE EATING CONTEST

ENTRY FORM

Saturday, June 19th, 2010 - Asbery Field

First Name      Last Name      Male Female

Birthdate (MM/DD/YY)          Age    

Address    

City          State     WA BC ID OR Other      Zip Code    

Home Telephone       

The entry fee is $3.00 for children and $5.00 for teenagers and adults with all proceeds going to the Marysville Food bank.  Collection food bins will be available with a can of canned food equal to $1.00 off the entry fee. Please check the age group that you will be competing in:

I hereby release Maryfest d.b.a. the Marysville Strawberry Festival, the Marysville School District #25, the City of Marysville, officers and/or agents whose property and/or personnel are used, from all claims, demands, damages, actions, causes of actions or suits of any kind or nature, including claims for any and all injury and property damage or loss sustained as a result of any accident which may occur during this event during Strawberry Festival 2010. That this release is expressly intended to cover and include all claims civil or otherwise past, present or future which can or may ever be asserted by the undersigned, their heirs or others as a result of injuries, illness, disease or damage to property of aforesaid persons or effects or consequences thereon.  The undersigned hereby declares that the terms of this agreement have been completely read and are fully understood and voluntarily accepted. I hereby certify that I am in good physical condition and am able to compete safely in this event. I will, in addition, permit the use of my name and pictures in broadcasts, telecasts, newspapers, brochures, etc. As a participating performer, I certify that all information in this form is complete and true.

Signature Date

Parent/Guardian Signature   

(if entrant is under 18 years old)

Printed Name of Contestant

Please return form to:                                                      

Maryfest

c/o Shortcake Eating Contest Committee

P.O. Box 855

Marysville, WA 98270

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