Member Community Event Waiver

Member Parade Event Waiver

Please complete this form in its entirety before participating. This waiver must be submitted for every participant, including minors. Participation is limited to individuals personally invited by a Benton Fire District 2 member.

If you were not invited by a current Benton Fire 2 member, please contact the Fire District Administration Office at 509-588-3212.

Citizen Ride-Along Waiver Community Event Waiver

Member Community Parade Event Waiver

Events: (required)

Benton City Daze Parade

Fourth of July Parade

Winterfest Parade

Other:

Other Event List Here:

Participant Name (first, last): (required)

Benton Fire 2 Members Name: (required)

Participant Date of Birth (DOB): (required)

Participant Phone: (required)

Participant Mailing address:

City, State, Zip Code:

Participant E-mail:

If the participant is under 18 years of age, a parent or legal guardian must complete and sign this form. Children of any age may participate when accompanied and sponsored by a Benton Fire 2 member. Is the participant a minor?

Yes, participant is a minor.

No, participant is over 18 years old.

Parent/Guardian Name

Parent/Guardian Phone Number:

Any Medical Conditions: (required)

ASSUMPTION OF RISK & WAIVER — Check all boxes before signing. (required)

I acknowledge that riding on fire district apparatus during a parade or community event involves inherent risks including but not limited to movement of large vehicles, uneven surfaces, crowd activity, and other conditions outside the control of Benton County Fire District 2. I voluntarily assume all such risks on behalf of myself and, if applicable, the minor participant named in this form.

I release and hold harmless Benton County Fire District 2, its officers, employees, and volunteers from any claims, injuries, or damages arising from my participation or the participation of the minor in this event. I confirm that all information provided is accurate and that I have the authority to sign on behalf of any minor participant listed.

Signature/Full Name (Participant/Guardian): (required)

Date: (required)

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