June 29, 2007 - July 1, 2007, Lewis and Clark State Park, Washington
By signing this statement I give permission for my child/legal ward _____________________________
to attend this event. I also hereby hold harmless in the event of any injury, illness, accident, death
or damage to personal or public property the organizers and attendees of this event, the State of
Washington and all counties therein,
and the Washington State Parks Service.
Name: ____________________________________________________________
Address: _________________________________________________________
__________________________________________________________________
Phone Number: ____________________________________________________
Signature/Date: __________________________________________________