City of Indian Rocks Beach Holiday Lighted Boat Parade Saturday, December 16, 2017 No Entry Fees – All Are Welcome Please print information Owner’s Name ____________________________________________________________________ Address __________________________________________________________________________ E-mail _______________________________ Phone # (H) (O) ____________________(Cell) Boat’s Name _______________________________________________________________________ FL # ________________________ Division: Power Boat Sail Boat VHF Radio: Yes / No Length ______________ Draft Parade Working Channel: VHF 68 I WILL/WILL NOT be attending the Award Ceremony on Monday, December 18, 2017 At 7:00 p.m., at Jimmy Guana’s, 401 2 nd Street, Indian Rocks Beach. # Attending: ________ Agreement to Assume Risk and Hold Harmless In consideration of being permitted to participate in the City of Indian Rocks Beach Holiday Lighted Boat Parade @ Holiday Inn Harbourside, and being fully knowledgeable of the risks while boating day or night, I agree to hold harmless the City of Indian Rocks Beach and the Holiday Inn Harbourside, their officers and the Event Committee, in the performance of their duties from any and all damages, losses, claims, suits, actions, expenses or liabilities which may directly or indirectly arise from participation in the Parade. _____________________________ Signature ________________________________ Date PLEASE RETURN THIS ENTRY FORM NO LATER THAN Friday, December 1, 2017 TO: Lorin Kornijtschuk~ E-MAIL: [email protected] OR FAX: (727) 595-4627 Please call Lorin at (727) 595-2517 for further information City of Indian Rocks Beach 1507 Bay Palm Blvd. Indian Rocks Beach, Fl. 33785