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Make checks to Siol Na h’Eireann

Mail to SNH Pipes & Drums, 138 Woodlot Rd, Ridge, NY 11961


Name: _______________________________________________

Age: ______        Sex______      Shirt size:  S / M / L / XL


 DOB: ____/____/____            email :________________________________ Phone:_________________ ___

 Please complete the entry blank, read the following statement, and sign below:

In consideration of your accepting this entry, I the undersigned, intending to be legally bound, hereby waive and release and hold harmless USA Track and Field, Siol Na h’Eireann Pipes & Drums, the Town of Brookhaven, Suffolk County, all sponsors and their representatives, successors and assigns, for any and all liabilities, claims, demands and causes of action whether or not arising in whole or in part out of the negligence of any of the above organizations or individuals. 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. If signed by a parent, the parent agrees to release and hold the above-named organizations and personnel harmless of any claims and rights which may be asserted on behalf of the entrant.

Further, I hereby grant permission to any and all of the foregoing to use any photographs, video, recordings or any other record of this event for any

Signature (Parent if under 18): _______________________________________

Date: ________________