Thank You for your Interest in the Moolah Shrine Circus Parade
PARADE ENTRY FORM
ORGANIZATION: ______
CONTACT NAME: ______
ADDRESS:______
CITY:______STATE:______ZIP: ______
PHONE: ______
EMAIL:______
PARADE DAY CONTACT (IF DIFFERENT FROM ABOVE):______
PARADE DAY CONTACT NUMBER (IF DIFFERENT FROM ABOVE):______
DESCRIPTION OF ENTRY______
NUMBER OF PEOPLE______
SIGNATURE______
Mail Application and Waiverto the Moolah Shrine Circus 12545 Fee Fee Rd. St. Louis, MO 63146 or email it to
AND
Email to the Parade Marshal Wayne Price at
REQUIRED: Proof of Insurance for ALL Entries in the Parade.
Parade Waiver
WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTIONS OF RISK FOR ALL PEOPLE INVOLVED WITH YOUR PARADE ENTRY.
Please read this form carefully and be aware that in signing up and participating in the Moolah Shrine Circus Parade, you will be expressly assuming the risk and legal liability and waiving and releasing all claims, damages or losses which you, your staff or your volunteers, minor children might sustain as a result of participating in any and all activities connected with and associated with said program/activities (including transportation services / vehicle operations when provided).
I recognize and acknowledge that there are certain risks of physical injury to participate in this parade and I voluntarily agree to assume the full risk of any-and all injuries, damages or losses, regardless of severity that my staff or my volunteers, minor children or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I, my staff or my volunteers, or my minor child may have (or accrue to me or my child) against the Moolah Shriners, including its employees, and volunteers including claims of negligence.
I do hereby fully release and forever discharge the Moolah Shriners from any-and all claims for injuries, damages, or loss that my staff, my volunteers, my minor child arising out of connected with, or in any way associated with the Moolah Shrine Circus Parade, programs / activities, including claims negligence.
I also agree to grant full permission to the Moolah Shriners to use my name, photo, video or recording for publicity or promotional purposes without obligation or liability to me, my staff or family.
All Participants/Groups will be REQUIRED to furnish Moolah Shrine a "Certificate of Insurance" with a minimum of $1,000,000 to cover our five entities: Moolah Temple A.A.O.N.M.S., Moolah Shriners, Moolah Temple Charity and Activities Association, Shriners Hospitals for Children (A Colorado Corporation), Shriners International (An Iowa Corporation) as an additional insured on a primary and non-contributory basis.
The Moolah Shriners reserve the right to refuse participation or any entry that does not provide representation and all required documentation.
I have read and understand the above Waiver and Release of All Claims and Assumption of Risk. Your signature below represents your understanding of this policy.
Signature of Participant ______DATE ______
Float Name or Organization ______