___________________________________________________________Participants First NameMILast Name_____________________________________________________Parent/Guardian NameEmail Address___________________________________________________________Participant AddressCityParticipant Date of Birth_____/_____/_____Gender: M or F_____________________________________________________Home Phone #Parents Cell/Work #_____________________________________________________Emergency ContactRelation__________________________Emergency Contact Phone #Grade:___________School:___________________________WAIVER FOR PARTICIPANTI do hereby acknowledge that I, or my child, participate voluntarily in the program sponsored by the City of Wooster, Police Department, Recreation Department and business and organizations associated with the Bicycle Rodeo event. I declare that my health and physical condition, or that of my child, is adequate to meet the requirement of the program. I covenant and agree to indemnify and hold harmless the City of Wooster and its representatives, instructors and volunteers against and from any and all costs, damages, or expense arising from any accident or other occurrence causing injury to myself, my child or any other person or property during participation in this program. By registering for, participating in or attending any City of Wooster program, you agree to allow publication of any photos taken at any program, event or facility in the City of Wooster._____________________________________________________Signature of Parent/GuardianDate