You Re Invited to Gather Your Scariest Friends

2009 HAUNTED TRAIL Sponsored by POTTSVILLE RECREATION October 16th & 17th You’re invited to gather your scariest friends (you know the ones we mean) and plan to be part of this ghoulsome event. Stage a fright scene at this year’s Haunted Trail and be eligible for cash prizes, paid to the most ghastly, horrific and dreadfully gruesome scene on the trail.

Participants must be over 18 or accompanied by an adult.

PARTICIPANT REGISTRATION FORM

NAME OF GROUP OR INDIVIDUAL CONTACT

PHONE EMAIL

AVAILABLE: Friday Saturday

GROUP SIZE

Organizational meetings are held every 2 weeks on Tuesday evening starting August 18th from 7:00-8:00 PM at the Humane Fire Company, 3rd Street & Laurel Boulevard. For information call 622-1234 ext346.

AGREEMENT TO PARTICIPATE I am aware that participating in any physical activity can be dangerous involving risks of injury. I also acknowledge that I am aware that the Recreation Commission carries no medical insurance on participants and that any injury incurred must be covered by my personal medical insurance. HOLD HARMLESS RELEASE The undersigned individual (parent or guardian if under 18), represents that the registrant is in good health and can participate in the above listed program activity and with prior knowledge of the physical nature of the activity releases the Pottsville Recreation Commission, City of Pottsville and the Department of Parks and Public Property, their employees, agents and members from any and all responsibility for injury to the registrant through negligence or otherwise while he/she is participating in the activity. The Parent or Guardian or participant assumes all risk inherent in the activity and will hold the Pottsville Recreation Commission, City of Pottsville and the Department of Parks and Public Property, their employees, agents and members harmless from any and all claims or causes of action that may arise from this activity. The undersigned individual also hereby gives permission to the Pottsville Recreation Commission, the City of Pottsville and the Department of Parks and Public Property to use photographs of this participant for the promotion of the Pottsville Recreation Commission events and programs. The participant agrees to hold the City of Pottsville, their employees and members free and harmless from liability, action claims and damages of every kind and nature whatsoever. My signature on this document is also intended to bind my heirs, representatives, executors, administrators, successors and assigns.

Signature of participant (parent if under 18) date