Needham Historical Society






~ PARTICIPANT INFORMATION ~

PLEASE NOTE: Participation as a REENACTOR in this event is by invitation only. For information, please contact Kenneth Siegel, rangerken98@yahoo.com.

All Participants ~
Print this page, then fill out and bring to the Registration Tent at the time of the event.
(print page, pdf version)

Vehicle and Participant Registration Form
"The Battle for Needham" May 21-22, 2011, Needham, MA
at the RIDGE HILL RESERVATION, Charles River Street, Needham

Unit: ________________________________________________________

Vehicle Make and Type:________________________________________

Vehicle Registration Number:____________________ State:___________

Number of Participants in Vehicle (List names below):________________


Participant Names:
1. ___________________________________________________________

2. ___________________________________________________________

3. ___________________________________________________________

4. ___________________________________________________________

CONSENT TO PARTICIPATE AND RELEASE OF LIABILITY
By signing this document, I expressly state that I am aware that participation with this event includes may result in lack of sleep, physical injury, insect bites, heat exhaustion, rashes from plants, exposure to freezing temperatures and/or burns. I acknowledge that I am responsible for my own safety and my own health care needs, and for the protection of my property.

Needham Tercentennial, Inc., the Town of Needham, the Needham Historical Society, the 2nd Massachusetts Regiment, and His Majesty’s 10th Regiment of Foot have made no representations or claims as to the condition or safety of land, structures or surroundings, whether or not owned, leased, operated or maintained by the site owners.

I understand that all activities are VOLUNTARY and that I do not have to participate unless I choose to do so. I understand that these activities are potentially dangerous or harmful to my person or property, and that by participating I voluntarily accept and assume the risk of injury to myself or damage to my property.

I indemnify, and hold harmless all of the above named sponsoring organizations, and any agent, officer, or employee of those organizations, acting within the scope of their duties, for any injury to my person or damage to my property.

This document is complete unto itself and that any oral promises or representations made to me concerning this document and/or its terms are not binding upon the above named sponsoring organizations, nor any officer, agent, or employee of those organizations .

Signatures of above named Participants


1.____________________________ 2.___________________________

3._____________________________ 4.___________________________


Copyright 2011, Needham Historical Society