Punkin Chunkin Registration

Team Name (required)

Machine Name (if different)

Captain's Name (required)

Team Members (required)

Captain's Address (required)

Captain's Phone (required)

Captain's Email (required)

Comments/Points of Interest About Your Team

Would you like to participate in the Versailles Pumpkin Show Parade on Saturday, September 24, 2016? We will group the participants together.
YesNo

I am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all inherent risks of property damage, personal injury or death. I further agree to indemnify and hold harmless the Versailles Lions Club and/or the Versailles Pumpkin Show and their agents for any and all claims arising as a result of my engaging and/or receiving instruction in Punkin Chunkin.

Furthermore, I agree the machine I/we are entering into competition has been fired repeatedly and reliably and has done so a minimum of 10 times prior without failure.

I AGREE TO THE ABOVE TERMS