2008 North/South Hunt RELEASE / ENTRY
FORM
Name__________________________________________________
Address________________________________________________
City/State/Zip___________________________________________
Email__________________________________________________
Phone______________________________
Internet nickname (optional)_______________________________
Emergency contact: _____________________________
Phone:_______________________
List any medical conditions/allergies
______________________________________________________________________
I, ___________________________________ by my signature below, release
and discharge the landowner(s), landowner heirs, leasee, manufacturers,
Larry Cissna (The Treasure Depot), or any other parties connected with
the Larry Cissna (The Treasure Depot) events, herein referred to as
"Releasees", of all law suits, actions and demands whatsoever, for all
claims, accidents, loses, or injuries that may occur while
participating in the Larry Cissna (The Treasure Depot) events. I
understand that the entry fee is non-refundable.
I hereby agree to indemnify and hold harmless the Releasees (Larry
Cissna & The Treasure Depot) and their insurance carrier, and each
of them from any loss, liability, damage or cost they may incur arising
out of or related to the event(s) whether caused by the negligence of
the Releasees or otherwise. I,
___________________________________________ by my signature, agree to
never return to any Larry Cissna (The Treasure Depot) hunt sites unless
participating in a Larry Cissna (The Treasure Depot) event. I fully
understand that if I do, my name will be barred from ever attending
another Treasure Depot hunt.
I will abide by the rules established by Larry Cissna, and property
owners/caretakers.
Date: ____________________
Signature: _________________________
Printed Name: _____________________________
Make all checks payable to: Larry Cissna
Mail completed form and $200 fee to:
Larry Cissna
1412 Camellia Dr
Sweeny TX 77480