PRINT AND MAIL WITH PAYMENT TO:

BARNEGAT RECREATION, 900 W. BAY AVE,  BARNEGAT, NJ  08005

Registration will continue until the class or activity is full.

Unsigned, incomplete or forms received without payment will be returned.

Payment Info:  Credit Card Company: (Visa, MC)______CASH_________
Card Number:_______________________ Exp:_____

Email:   _________________________________________________________

In consideration of the acceptance of my application for entry into the above event, I hereby waive, release, and discharge any and all claims for damages for death, personal injury, and/or property which I may have, or which hereafter accrue to me, against the entity ad result of my participation in the event. This release is intended to discharge the entity, its agents and employees, and any other involvement municipalities or public entities from and against any liability may arise out of negligence or carelessness on the part of persons or entities mentioned above.  I further understand that accidenst and injuries can arise out of the event; knowing the risks, nevertheless, I hereby agree to assume those risks and release and to hold harmless all of the persons or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or my heirs or assigns) for damages. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assigns.

________________________________ Date______________
Signature of Participant/ Parent/ Legal Guardian