Pumpkin Chunkin Contest Entry Form - Framework

Pumpkin Chunkin Contest Entry FormOctober 20, 2018 – 11:00am to Noon (setup)All paperwork is due by October 14th!!(please email to Kristi Henson at khenson49@gmail.com)Pumpkin Chunkin is limited to the first 4 entries in each category! (Rules subject to final review for safety)Organization:Team Name for Publishing:Name of Sponsoring Adult:Mailing Address:Phone: Home/Cell: Work:Your team represents (check one):Entry fee: 30 Youth –Ages 11 – 17, includes Elementary / Junior High / High School /Civic Group. Adults may assist with power tools and safety related tasks.Entry fee: 35 Collegiate Groups, must be enrolled in a college or community college.Entry fee: 50 Adult Group 18 and older.Check Your Category - Please check all that apply. This will help us determine placing more quickly.We reserve the right to merge categories based on participation.CatapultTrebuchetSling ShotPrizes will be awarded for greatest distance in each age category best of 3attempts. The grand prize trophy will be awarded for the overall distancewinner. (Excludes Demo Shots)1

Information about your team (for any publication of our choosing – share information /accomplishments of your team with others.)We encourage you to email photos of the teams working on the project tokhenson@citywidehomeloans.comInformation about your deviceDescribe your machine type (i.e.: catapult or trebuchet).Arm Length:Describe any human Power Adder (ie: pedal, cranks, gears, winch)2

List All Team MembersAll team members in pit must have waivers on file prior to any launch activity. Only 10members are allowed in the pit. Teams may alternate members in pit between throw ifhave more than 10 members.Describe safety precautions reviewed with team during practices.Please return entry forms and registration fees to:Wickenburg Rotary Club, PO Box 1018, Wickenburg, AZ 85358 by October 14thCan email forms to kristi49@gmail.comBring acknowledgement of risk forms with you the day of the event for each teamparticipant.Each team will receive 10 passes (or one for each member up to 10 member) to theevent. Those without a pass will be required to pay admission at the gate.3

ADULT RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENTI,Print First NamePrint Middle NamePrint Last Namehereby acknowledge that I have VOLUNTARILY applied to participate in pumpkincatapult/trebuchet recreational/sporting activities. I understand, and I am aware thatpumpkin catapult/trebuchet is a hazardous activity. I understand that pumpkincatapult/trebuchet and the use of catapult/trebuchet devices involve a risk of injury andthat there is a possibility that I could be injured while participating in this activity.I hereby agree to, and expressly assume the risks of injury while engaged in pumpkincatapult/trebuchet recreational/sporting activities, whether during the preparations,loading and unloading, triggering or travel to or from the firing area.I hereby irrevocably release the Wickenburg Rotary Club and the Town of Wickenburg,their employees, volunteers, sponsors, agents, successors, heirs, assigns, affiliates, andlegal representatives [“Released Parties”] from all claims, rights, demands, or actions forordinary negligence which I or my successors, heirs, or assigns may have against theReleased Parties in connection with the Hassayampa Harvest Hurl 2016 activities. I agreenot to make a claim against or sue the Released Parties for injuries, death, or propertydamages relating to the catapult/trebuchet activities and/or the use of thecatapult/trebuchet equipment, even if any injury, death, or damage is caused to me or myproperty due to the ordinary negligence of the Released Parties or the dangerouscondition of any property upon which the catapult/trebuchet activities may take place.I further understand and agree that this release extends to all claims for ordinarynegligence, known or unknown, suspected, or unsuspected, arising out of thecatapult/trebuchet activities.I hereby agree to and accept the terms and conditions of this Release of Liability andAssumption of Risk Agreement. This Release of Liability and Assumption of RiskAgreement constitutes the final and entire agreement between the Released Parties andthe undersigned concerning this subject matter.In the event of litigation with respect to the catapult/trebuchet activities of thisagreement, the prevailing party shall be entitled to recover attorney fees and the costs oflitigation. I certify that I am eighteen years of age or older and that I have no medical ormental condition that prevents me from participating in the catapult/trebuchet activities.I have carefully read this Release of Liability Agreement and I fully understand it.Team NameSignaturePrint Full NameDate4

MINOR RELEASE OF LIABILITY AD ASSUMPTION OF RISK AGREEMENTI, , the parent or legal guardian of(print full name of child) herebyacknowledge that I have VOLUNTARILY agreed to allow said child to participate inpumpkin catapult/trebuchet activities.I understand, and I am aware that pumpkin catapult/trebuchet is a hazardous activity. Iunderstand that pumpkin catapult/trebuchet and the use of catapult/trebuchet devicesinvolve a risk of injury and that there is a possibility that the child could be injured whileparticipating in this activity.I hereby agree to, and expressly assume the risks of injury while the child is engaged inpumpkin catapult/trebuchet recreational/sporting activities, whether during thepreparations, loading and unloading, triggering or travel to or from the firing area.I hereby irrevocably release the Wickenburg Rotary Club and the Town of Wickenburg,their employees, volunteers, sponsors, agents, successors, heirs, assigns, affiliates, andlegal representatives [“Released Parties”] from all claims, rights, demands, or actions forordinary negligence which I, or the child, or our successors, heirs, or assigns may haveagainst the Released Parties in connection with the Hassayampa Harvest Hurl 2016activities. I agree not to make a claim against or sue the Released Parties for injuries,death, or property damages relating to the catapult/trebuchet activities and/or the use ofthe catapult/trebuchet equipment, even if any injury, death, or damage is caused to thechild or property due to the ordinary negligence of the Released Parties or the dangerouscondition of any property upon which the catapult/trebuchet activities may take place.I further understand and agree that this release extends to all claims for ordinarynegligence, known or unknown, suspected, or unsuspected, arising out of thecatapult/trebuchet activities.I hereby agree to and accept the terms and conditions of this Release of Liability andAssumption of Risk Agreement. This Release of Liability and Assumption of RiskAgreement constitutes the final and entire agreement between the Released Parties andthe undersigned concerning this subject matter.In the event of litigation with respect to the catapult/trebuchet activities of thisagreement, the prevailing party shall be entitled to recover attorney fees and the costs oflitigation. I certify that I am eighteen years of age or older and that said child has nomedical or mental condition that prevents the child from participating in thecatapult/trebuchet activities.I have carefully read this Release of Liability Agreement and I fully understand it.Team NameSignature of Legal GuardianPrint Name of Legal Guardian Date5

pumpkin catapult/trebuchet activities. I understand, and I am aware that pumpkin catapult/trebuchet is a hazardous activity. I understand that pumpkin catapult/trebuchet and the use of catapult/trebuchet devices involve a risk of injury and that there is a possibility that the child could be injured while participating in this activity.