Knoebel’s Grove Amusement Park Elysburg, PA Bring your family for a fun day at the park! Enjoy lunch, ride tickets and games at our reserved pavillion. Special awards, giveaways, & door prizes. Lunch begins at 11:30 $29 per person (includes lunch and ride tickets) $10 for children under age 4
Registration Form Driver Information Full Name ___________________________________________________________________________ Address _____________________________________________________________________________ Phone ___________________________________ Email ___________________________________ Passenger Information Full Name ___________________________________________________________________________ Full Name ___________________________________________________________________________ Full Name ___________________________________________________________________________ Full Name ___________________________________________________________________________ Registration Fees $29 per person x ________ = ________
total attending
$10 per child (under age 4) x ________ = ________
Total Cost
total attending
Total Cost
Payment Method • Mail a check payable to AASP-PA, or • Pay via credit card (please fill out form below) MC VISA Discover AmExp Exp. Date _____ Security Code (3 or 4 digits) __________ Card Number _______________________________________________________________________ Print name on card __________________________________________________________________ Billing Address ______________________________________________________________________ Signature ___________________________________________________________________________ Release and Waiver of Liability and Indemnity Agreement (for motorcycle riders)
In consideration of my entry in the AASP-PA Motorcycle & Car Run, I hereby waive, release and discharge any and all claims for damages, injury and property damage, which I or my successors may have, or which may hereafter occur as a result of my participation in this event. This release is intended to discharge in advance the officers, directors, promoters, sponsors, and their employees from and against any and all liability arising out of or connected in any way with my participation in the event. I am aware that motorcycling carries a significant risk of serious personal injury, death and property damage. I know the risks of danger to myself, my minor child (if present), and my property while participating in the event and while upon the event premises and, relying upon my own judgment and ability. I assume all such risks of loss and hereby agree to reimburse all costs to, and to forever hold harmless and indemnify, all persons and entities identified above, generally and specifically, from any and all liability for death and/or personal injury or property damage in any way from my participation in this event. Rider Signature ___________________________________________________________
Date ___________________
Passenger Signature ________________________________________________________ (or parent/guardian signature if passenger is under 18 years)
Date ___________________
Please mail this registation form (signed and completed) with payment to AASP-PA, 2151 Greenwood Street, Harrisburg, PA 17104 Registration MUST be received by Tuesday, May 29
