Street Address:

        City: State: Zip:

        Date of birth: Age:

        Parent/Guardian:

        Home Phone:         Cell Phone:

     The cell phone number is needed in the event of an emergency or child being lost, law enforcement officials may contact and re-unite you with your child.  (It does happen occasionally, please cooperate and provide your number.)

     The undersigned agrees that participation in this event can be dangerous and result in injury to child. Parent/Legal Guardian hereby releases the City of Eunice, Property owners of where the event takes place, and coordinators of this event from any and all legal responsibility for any injury suffered while participating in the Eunice Little Mardi Gras Run, knowing full well that this release must be granted as part of the consideration for allowing child to participate in the event.

     Further, below signed agrees to indemnify and hold harmless the City of Eunice, its officials and employees from any and all claims brought for personal injury or property damage to child or guardian and any blood relatives of said child or guardian, including the undersigned, by any person, said indemnity agreement to include legal fees and defense incurred by any indemnity.

       
             Parent/legal guardian                                                     Date

We Run RAIN OR SHINE
* NO REFUNDS*
NO ALCOHOLIC BEVERAGES ALLOWED ON RUN!