Daffest Deby Release Form
Saturday April 29th, 2017

PLACE: Lapan Highway
Please register by Wednesday April 22nd.
sign in and number pick up opens at 8:30AM at the top of the track!
Entry fee $20

Name:……………………………………………………………………………………………...

Address:……………………………………………………………………………………………

Telephone:………………………… Email:…………………………………………………………

Age Group:
5 - 8……………….. 9 -12………………..
13 - 15……………...16 and up…………..
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Participant Release
I agree that there is an inherent danger in the Daffest Derby. I agree not to hold
responsible the organizers, sponsors or land owners involved with this event liable
for any injury occurred by me /and or my minor child while participating
in this activity. I further give permission for my name and photograph
to be used for educational and publicity purposes related to the event,
the Saranac lake Chamber of Commerce, and the Daffest committee.
Furthermore, I release any and all royalties thereto.

ENTRANT SIGNATURE……………………………………………………………………………

Parent Signature (Required if under age 18)………………………………………………………

HOLD HARMLESS AGREEMENT
Daffest Derby / DAFFEST

_________________ (referred to herein as "User") does hereby covenant and agree to defend, indemnify and hold harmless the Village of Saranac Lake, NY (referred to herein as "Village"), to the fullest extent permitted by law in connection with the actual or proposed use of Village facilities, as identified in the associated Village of Saranac Lake Park Use Form, and/or the participation in the event known as THE DAFFEST DERBY
User agrees to indemnify and hold harmless the Village, its representatives, agents and employees from and against any and all claims, suits, liens, judgments, damages, losses and expenses, including legal fees and all court costs and liability (including statutory liability) arising in whole or in part and in any manner from injury and/or death of person or damage to or loss of any property resulting from the acts, omissions, breach or default by or of User, his/her family and/or invitees and friends, in connection with spectating, observing and/or participating in or of the activities, functions, events, affairs or proceedings of the DAFFEST DERBY, except as to those claims, suits, liens, judgments, damages, losses and expenses that were caused by the negligence of Village.
User will defend and bear all costs of defending any actions or proceedings brought against the Village, its officers, directors, agents and employees, arising in whole or in part out of any act, negligence, omission, breach or default of or by User. The foregoing indemnity shall include injury or death of the User or members of his/her family, friends, invitees, agents, or representatives and shall not be limited in any way by an amount or type of damage, compensation, or benefits payable under any applicable workers compensation, disability benefits or other similar employees benefit act.
User hereby expressly permits the Village to pursue and assert claims against the User for indemnity, contribution and common law negligence arising out of claims for damages for death and personal injury.

Dated: __________________

_____________________________ _________________________________
Village of Saranac Lake User

____________________________ _________________________________
(Print Name) (Print Name)