Age: Under 1 Year Old 1 Years Old 2 Years Old 3 Years Old 4 Years Old 5 Years Old 6 Years Old 7 Years Old 8 Years Old 9 Years Old 10 Years Old

First Name:
*

Last Name:
*

Street Address:
*

City:
*

State:
*

Zip Code:
*

Phone Number:
*

Emergency Phone Number:
*

E-Mail:
*

Date of Birth:
*

Gender:
Male Female

Comments/Questions :

Terms and Conditions:
We wish to participate in the Lago Vista 4th of July Family Activities. We, individual(s) or organization Indemnify and Hold Harmless the Lago Vista 4th of July Council and it's Volunteers, the City of Lago of Lago Vista, St. Mary's, Our Lady of the Lake Catholic Church, Rolling Hills Community Church and the Lago Vista Property Owner's Property Owners's Association from any and all claims, suits, losses, damages, expenses due to our participation in the Lago Vista 4th of July Family Activities. Further, the noted individual(s) or organization will defend the Lago Vista 4th and each of the above noted entities, and it's agents from all claims or bodily injury or property damage arising from their participation in the Lago Vista 4th of July Family Activities. We understand that we are responsible for our own safety and actions. By checking the box below, I, the individual named in the First Name and Last Name boxes above, sign that I have read this Agreement and understand and agree to all it's terms.

I agree to terms and conditions