2018 Hippie hill Registration


Fill out the form to register for the Hippie Hill Challenge

Name *
Name
Phone *
Phone
Sex *
Waiver *
WAIVER - In consideration of the foregoing, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive and release any and all rights, claims and courses of action I have or may have against The Hippie Hill Challenge, Brian Ricketts, their agents, employees, officers, directors, successors and assigns, and any and all sponsors, their representatives and successors, that may arise as a result of my participation in The Hippie Hill Challenge and any pre- and post- event activities. I understand that this event may cause serious bodily harm including broken bones and even death. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose including commercial advertising. I have read, understood, and accept the agreement above. My submission of this form shall act as my legal signature.