Parade Registration Form
Heritage Square, Peoria Heights, IL 61616
Parade: Saturday June 20, 2015, 10 AM. Check in: 9:00 AM
Register in advance at www.peoriaheightschamber.com or return this form by mail no
later than June 15 to the following address:
Peoria Heights Chamber of Commerce
PO Box 9783 Peoria, IL 61612
Group Name: ________________________________________________________________________
Contact Name: ______________________________________________________________________
Contact Address: ___________________________________________________________________
Contact Phone Number: ____________________________________________________________
Contact Email Address: ____________________________________________________________
Please describe your group and their parade presentation (to be used by the
parade emcee):
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________
Special needs for your group or additional comments:
__________________________________________________________________________________________
____________________________________________________________________________________
For questions you may call the Peoria Heights Chamber of Commerce at
309-282-7733
Note: Registration does not ensure placement in the parade
Duryea Festival Parade Release of Liability
Please sign and return one Release of Liability form for every adult or child participating in the
Duryea Festival parade. This form must be signed by a parent or guardian if the participant is
under the age of 18.
Return forms by mail to the Peoria Heights Chamber of Commerce, P O Box 9783 Peoria, IL
61612 before June 15, 2015.
Release of Liability
The undersigned is a participant in the Duryea Festival parade on Saturday, June 20, 2015.
By participating in the parade, the undersigned hereby agrees to assume all responsibility and
liability for any and all damage, personal injury, or other loss of any nature and further
releases and agrees to hold harmless the Peoria Heights Chamber of Commerce and its
agents from any and all liability, claims, damages, and causes of action of any nature related
to said parade.
The undersigned hereby acknowledges and certifies that he or she has read the Duryea
Festival Parade Release of Liability, fully understands the contents, and by signing below
agrees to all terms and conditions included therein.
________________________________________
Participant Name
________________
Age
________________________________________
Participant Signature
________________________________________
Parent or Guardian Signature (if under 18)
________________
Date Signed
___________________________________________________________
Address
___________________________
Phone Number
______________________________
Email address