Name *

First Name

Last Name

Phone

(###)

###

####

I hereby grant South Park Barbell Club (SPBC) the irrevocable right and permission to photograph and/or record me during the event and to use, reproduce, publish, and distribute such images or recordings for promotional and marketing purposes, including but not limited to use on the SPBC website, social media platforms (including Instagram), and other promotional materials. I waive any right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears, and I waive any right to royalties or other compensation arising from or related to the use of such media.

Yes

No

I acknowledge that participation in a powerlifting competition involves inherent risks of injury. By choosing to participate, I voluntarily assume all associated risks and hereby release, waive, and discharge South Park Barbell Club and Jayne Harris Esposito from any and all liability for personal injury, whether foreseen or unforeseen, that may occur as a result of my participation in this event. I affirm that I am physically capable of participating in the competition and understand the potential risks involved. I further agree to execute a full waiver of liability on the day of the event.

Yes

No

Do you want a Disco Ball Classic t-shirt? ($25)

Yes

No

I acknowledge that the event fee is $30 with a donation or $35 without. I agree to remit payment either via Venmo in advance or in cash on the day of the event.

Cash

Vemmo