Shamrock Around the Clock Registration

This document registers _____________________________ for the annual event

Shamrock Around the Clock, coming Friday, March 11, 2011 from 6:30 – 11:59 pm.

Shamrock Around the Clock is an annual event involving a dozen Cedar Rapids
area church youth groups and Christian organizations. It‟s a fun night designed
to develop teamwork, camaraderie, and wholesome fun, using a St. Patrick‟s day
theme. The main part of the night involves a scavenger hunt (utilizing adult
drivers) all over town, searching for the Leprechaun and his “Pot „o Gold”. Other features of the night are
the awards rally, a green food buffet, prizes for wearing green, best “green” song & dance, and more,
The cost is $10 per person..

Print out and bring this registration form with you to the event with
your parent’s signature(s) below. (18 year olds may sign for themselves).

Parent or Guardian Signature required below

and must be brought with you to Shamrock.

PHOTO AND INFORMATION RELEASE

“I hereby give permission for the use of pictures or video/audio recordings of the minor listed on this form for the purposes of promoting and
reporting Shamrock Around the Clock, including websites, without compensation to me or the minor.

LIABILITY RELEASE Shamrock Around the Clock is carefully planned and adequately supervised by mature adults. However, even with the best
of planning and precaution, unforeseen events can occur. Knowing this… “I agree to assume and accept all risks and hazards inherent in this
church-related social activity. I also agree not to hold any of the participating churches or their employees or volunteer assistants liable for
damages, losses, or injuries. I understand that I am signing for the minor listed on this form and in my own capacity as parent or legal guardian and
the signature below is for photo/information and liability release.”

Signature(s) of parent(s) or legal guardian(s) ______________________________________________________________________________________

Phone numbers where parents can be reached Friday, March 11, 2011 between 6:30 and 11:59 pm.

Name_____________________________________ Phone_____________________________ Relationship___________________________________

Name_____________________________________ Phone_____________________________ Relationship___________________________________

Alternate phone number(s)_____________________________________________________________________________________________________