Online Registration

Registration & Liability Form

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone*

###

####

Email*

Age*

Registration Fee $15
per person
Children under 7, Free

Children under 14 years of age must be accompanied by an adult and
listed on the adult's Registration and Liability Form as a responsible
contact for the minor at the event. The Frost Out Lymes staff appreciates your understanding of this critical safety measure.

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Signature of Consent to Represent
The registering adult is responsible for all minors under 14 years of age on this form.

Liability Release: The undersigned releases Frost Out Lymes and its representatives, along
with Field Park and the City of Mukwonago from any and all liability of any physical or mental
injury or anguish suffered during this fundraiser by all participants registered on this form. All
reasonable accommodations are being made to provide a safe environment for participants and
volunteers. In case of accidental injury, trained medical staff will be available at the event.

Signature of Liability Release Consent*

**Your electronic signatures on this document are considered binding of the agreement stated.**

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