In consideration of participating in the "Truck Pull" on July 4^th 2005 in Campbellsport, I attest to the fact that I understand the nature of the event and that I am qualified, in good health, 18 years old or older and in proper physical condition to participate in such event. I promise that, in the event conditions appear unsafe, I will immediately discontinue participation in the event.

I fully understand the event involves risk of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions or inactions, those of others participating in the event, the condition in which the event takes place, or the negligence of the "releases" named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and responsibility for losses, costs and damages I incur as a result of my participation in this event.

I hereby release, discharge and covenant not to sue the Campbellsport Fireman, Campbellsport Area Chamber or Commerce, Campbellsport Building Supply Center Inc., Tom's Quality Millwork, Valley Hydro-Excavation, Koffman Auto Body, Joel Fleischman, The Village of Campbellsport, their respective administrators, directors, agents, officers, volunteers, employees, other participants, sponsors or advertisers and, if applicable, owners and lessors of premises on which the "Truck Pull" takes place (each considered one of the "RELEASEES" herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "Releasees" or otherwise, including negligent rescue operations. I further agree that if despite this release, waiver or liability and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees: I will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage or cost which may incur as a result of such claim. I have read this release and waiver of liability, assumption of risk and parental consent agreement and fully understand it. I further attest by my signature that I agree with the conditions above.

By my signature below, I also give the Campbellsport Area Chamber of Commerce and  Joel Fleischman my consent to photograph and/or video me, with or without name, for educational, informational, or promotional purposes. Due to editing, I understand that I may or may not be featured in any publicity.

Date of event: July 4, 2005

By signing below I agree to the above terms and conditions (must be signed prior to competition):

1. ________________________ _________________________   

2. ________________________ __________________________

3. ________________________ __________________________

4. ________________________ __________________________

5. ________________________ __________________________

6. ________________________ __________________________

Business Sponsor or Team Name: _____________________________________________

Team Captain & Contact Person: ______________________________________________

Charity of your Choice _______________________________(must be a certified non-profit organization)

to receive the $250 if you win first place

(if nothing is indicated it will go towards the Campbellsport July 4^th Parade Fund)

Address: ____________________________________

____________________________________

Phone Number: ______________________________

E-Mail: ____________________________________

________________________________________ agrees to donate $100 to participate as a team in the 2005 Boom Pull. Participation includes 6 commemorative T-Shirts and one sponsor T-Shirt. Sponsorship and registration must be in by June 20^th. Limit of 15 teams.

5 people will pull the boom -- one will be alternate/cheerleader

1. __________________________________________________    _____________

2. _________________________________________________    ____________

3. __________________________________________________    ____________

4. _________________________________________________    ____________

5. __________________________________________________    ____________

6. __________________________________________________    ____________