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In consideration of your acceptance of this entry, I hereby, for my-self, my heirs, my executors and administrators, waive any and all of my rights and claims for damages I may have against sponsors, coordinating groups, and nay individuals associated with the event, their representatives, successors and assigns for any and all injuries suffered by me in connection with said event. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connections with said event. I have been warned I must be in good health to participate in this event. I give medical personnel permission to treat my injuries if I am unable to make the decision for myself. I also give permission for the free use of my name and picture in any broadcast, telecast or print media account of this event. In filling out this form I acknowledge I have read and fully understand my own liability and do accept the restrictions.