LIVERMORE KNIGHTS OF COLUMBUS 4TH ANNUAL Car Show Participant Registration Car Show Registration OWNER/PARTICIPANT ADDRESS:______________________________________ Single Car - $35.00 (includes $10 in food/drink tickets) Discount for additional cars by same participant - $5.00 per car CITY:__________________STATE_____ZIP___________ Discount for registrations paid by April 1, 2014 - $5 per car YEAR:_______ MAKE:__________MODEL:___________ Total # of Cars to be registered __________ (please attach separate form for each car) NAME:_________________________________________ COLOR:______________ MODIFIED: YES____ NO____ Total Amount Enclosed: $_____________ PHONE:_________________________ Make Checks Payable to: EMAIL ADDRESS: _________________________________ Knights of Columbus #4588 P.O. Box 1007 Livermore, CA 94551-1007 (please print carefully; we will send your confirmation via email)  The Livermore Knights of Columbus reserve the right to refuse or remove anyone that is deemed to disturb the event or endanger others at the event.  The City of Livermore mandates that there shall be no dogs, skateboards or bicycles allowed at the event  Participant Vehicles must remain parked in their assigned location until the event is over at 4:00PM The event will be held Rain or Shine When Where Saturday May 10, 2014 10:00 am to 4:00 pm Monsignor Adams Field (adjacent to St Michael School) 263 Church St, Livermore For additional information email: [email protected] or call: 925-525-8833 Proceeds To Benefit Knights of Columbus Charity Sponsorships You must read and sign the back of this form in order to complete your registration Acknowledgement of Risk: I hereby acknowledge that I have voluntarily chosen to participate in the activities of the Livermore Knights of Columbus Rib Cookoff & Car Show on May 10, 2014. I recognize that the activities involve risk of injury and I agree to accept any and all risks associated with them, including but not limited to property damage or loss, minor bodily injury, severe bodily injury, and death. Furthermore I recognize that participation in the Show activities involves activities and risks incidental thereto, including but not limited to, travel to and from the event and the possible negligent or reckless conduct of other participants. I am voluntarily participating in the activities with the knowledge of the risks involved and hereby agree to accept any and all inherent risks of property damage, bodily injury, or death. Indemnification and Hold Harmless: In consideration of my participation in the activities and to the fullest extent permitted by law, I agree to indemnify, defend and voluntarily hold harmless the Livermore Knights of Columbus, its officers, directors, agents, volunteers, venders, sponsors, Saint Michael School, Saint Michael Church, Saint Michael Parish, the Oakland Diocese, the City of Livermore, other participants, sponsors, and any vendors from any and all claims, both present and future, that may be made by me, my family, estate, heirs or assigns arising out of or resulting from my participation in the activities of the Livermore Knights of Columbus Rib Cookoff and Car Show. CClaim as used in this agreement means any financial loss, claim, suit, action, damage, or expense, including but not limited to attorney’s fees, attributable to bodily injury, sickness, disease or death, or injury to or destruction of tangible property including loss of use resulting there from. I further understand that this acknowledgement of risk and hold harmless is intended to be as broad and inclusive as permitted by the laws of the State of California and that if any portion hereof is held invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect. I also understand that the Livermore Knights of Columbus does not provide any medical or dental insurance or life insurance to cover bodily injury, illness or death, nor insurance for property damage or omissions; and I acknowledge that I am completely responsible for my own insurance or other financial sources, to cover these expenses. Execution of this Form: By signing below, I acknowledge that I have read, understand, and agree to this Risk and Hold Harmless Agreement. Additionally, 1) I agree that my vehicle will be shown solely for display purposes and hereby grant permission to the Livermore Knights of Columbus to use photos of my vehicle in any publications, including, but not limited to brochures, advertisement, TV promotion, etc.; 2) I agree to abide by all safety and security procedures applicable to this event; 3) I further declare that I carry insurance coverage for the vehicle(s) that I have registered for this event, and; 4) I certify that I am over 18 years of age (if not, a parent or legal guardian must sign on behalf of the participant). OWNER/PARTICIPANT SIGNATURE:_____________________________________________ DATE:________________________________ 2014 Livermore Knights of Columbus Rib Cookoff & Car Show – Car Show participant registration form Page 2