Last Name:_______________________________________First Name:______________________

Address:_________________________________________________________________________

City:__________________________________________________State:_______  Zip:___________

Home Phone:____________________________    Other Phone:____________________________

Email address(please print):_______________________________@_______________________

Instrument/auxiliary:____________________________    Section or Group: ___________________

Do you have an instrument?Y / N   Years Played? _____   Joined Rounders _________

Will you need a uniform shirt? Y / N    Shirt Size:  S/M/L/XL/XXL/XXXL    Hat? Y / N

Misc information that we use to obtain grants:
School________________      Profession_______________________   Hometown______________

I affirm by signing below that I am over the age of eighteen (18), and that I am competent to make this release, for myself, my heirs, executors, administrators, and assigns and agree to and do hereby absolutely and unconditionally release and discharge the Second Time Arounders^® Marching Band, Inc., Findeison Enterprises, Inc., Bringe Music Center, Melissa Mince, Esq., the City of St. Petersburg, St. Petersburg Festival of States, the Suncoasters of St. Petersburg, Inc., and any and all other entities and individuals, their respective officers, directors, employees, agents, and representatives, past and present, and the respective successors and assigns, from all claims, demands, actions, causes of action, liabilities, obligations, losses, damages, penalties, and expenses, of whatever nature, which arise out of or are in any way connected with or relate to any activities having to do with my participation in the Second Time Arounders^® Marching Band, including, but not limited to, rehearsal and/or performance. I hereby acknowledge that participating in marching band activities may be deemed to be dangerous activity and therefore, I am knowingly and intentionally entering into this release of my own free will. I further warrant that no promise or inducement has been made to me to enter this release; that this release is executed without reliance upon any Statement or representation by the parties being released or their attorneys and other representatives concerning the nature and extent of the claims and damages or legal liability therefor.

IN WITNESS WHEREOF, this Release is given on this ____ day of _____, 20_____.

YOUR NAME: (Signature)__________________________  
WITNESSES:(Signature)______________________ (Print Name)_________________