Use ONE ENTRY FORM PER Event ENTERED (Photo copies are acceptable)

For Official use Only Barcode: ___________ Paid: ______________

Entry Fees:
 - RIDING CLINIC $60
 - POKER RUNS $20 ($10 Pee Wees)
 - TEAM RACE $40
Sign Up: Sat. 7-8:30am for Clinic and all day for Games and Sunday Events
Sun. 8-10:00am
Send entry to: Attn: DH Fun Run Cross Road Adventures, Inc.
PO Box 62185 Boulder City, NV 89006
MAKE CHECKS PAYABLE TO DANNY HAMEL MEMORIAL FUND

Name: ___________________________________________Address: _______________________________________

City: ____________________________________________State: ____Zip: _______Age: ____ DOB: _______

Phone #: _________________________________________Make of M/C: ____________________________________

Check One BoxSATURDAY Dec. 14thCheck One Box

Check One BoxSUNDAY Dec. 15thCheck One Box

WAIVER INDEMNIFICATION AND RELEASE:
I the undersigned, do hereby for myself, my heirs, executors, and assigns, release, remise and forever discharge and agree to indemnify and hold harmless individuals, officers, agents, sponsors, sanctioning bodies, servants employees of and from every claim, demand, action or right of action whatsoever kind or nature and any cost, lost or expense in connection therewith arising from or any reason of, or on the occasion of any use by, of the Cross Road Adventures Inc. course or related facilities including any claims or demands for injury to, or death of any person or damage to, or destruction of, any property resulting from or claim to result from or arise out of accident or occurrence during or in connection with said use including specifically such as may arise out of or be claimed to arise out of negligence on the part of said Cross Road Adventures Inc., its individuals, officers, agents, sponsors, co-sponsors, sanctioning bodies, servants and employees.
This waiver indemnification and release is given and this agreement is made in consideration of and as a condition to permitting the undersign to use course or circuit facilities or act as an official or spectator or participant or to be present in any other capacity whatsoever at said event. I have read the foregoing of this instrument or to make representations contrary to the provisions hereof.
I hereby grant Cross Road Adventures Inc., it's media licensees and assigns, permission to use and publish, in any media now or hereafter known, my name, likeness and voice as captured at any Cross Road Adventures Inc., event, for purposes of promotion, art and commerce.
It is further understood and agreed that in the event I am injured from whatsoever cause during the event, covered by the application, I herewith consent and authorize first aid and ambulance service as provided by sponsoring club, organization or landowner, and further hold all parties harmless from any consequences of said aid.
Under the rules of Cross Road Adventures Inc., I here by Agree to conform and comply with the rules governing this contest.
I declare that the rider listed on this entry application possess the standards of competence necessary and is physically fit for an event of this type for which this entry relates and the vehicle entered is roadworthy and suitable for this event. This is a dangerous sport, by signing, you are certifying that you have read and understand this Waiver Indemnification and Release.

Signed: _________________________________________________________________ Date: ____________________

Parent or Guardian Signature: _______________________________________________ Date: ____________________