Castra Romana

Individual Registration

(one per participant)

Name:_______________________________________________________

Address:_____________________________________________________

City:____________________________ State:_________ Zip:_________

Email:______________________________________________________

Phone Number:____________________hm______________________wk

Cell Number:________________________________________________

Organization:________________________________________________

Impression:__________________________________________________

Weapons:____________________________________________________

Arrival Day:______________________ Appx Time:_________________

Emergency Contact:___________________________________________

Medical Conditions:___________________________________________

____________________________________________________________

____________________________________________________________

Medications:_________________________________________________

I, ___________________________________, in consideration of this application to participate in the above names activity, do hereby agree to release and forever hold harmless The State of South Carolina, Givhans State Park, ISPA, and Legio VI, theirn members, managers, directors, employees, successors or assigns, from any liability due to injury or illness that I may incur as a result of participating in this activity.  I have read and understand this Release of Liability and have had the opportunity to discuss any questions I may have.  I further agree that this release is to serve as a waiver of any claims due to injury or illness to myself, for anyone that may make claim against the above listed parties on my behalf or on behalf of my estate, or as a result of my injury or illness.  I further understand that Roman Era reenacting is physically demanding, involves the use of weapons, and fire, and that I am responsible for my own actions.

_________________________________________________________     __________________________

Registrant Signature                                                                                             Date

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