SOUTHERN STARRS
Equine and Animal Assisted Activities
SCAVENGER “FOX” HUNT Registration Form (Please print clearly)
Saturday, August 8th, 2015 Rain or Shine
8:30 a.m. Registration and Continental Breakfast, Lebanon Chamber of Commerce
2:30 p.m. Silent Auction and Tally and Door Prizes – Refreshments, Charlie Daniels Park
Approximately 3 p.m. Fox is Caught - GRAND PRIZE WINNER ANNOUNCED
Team Leader Name: ______________________________________Email: _____________________________
Home Phone: _______________________Cell/Emergency. Phone: ___________________________________
Street Address: _____________________________________________________________________________
City/State/Zip: _____________________________________________________________________________
Parent/Guardian Name (If under 18): ____________________________________________________________
(LEAD TEAM MEMBER MUST BE 18 OR OVER)
Entry Fee $25.00 per Team Member 12 and over: Total amount_______________
 Check Enclosed
 Paid via website
There will be no refunds, however team member substitutions are permitted.
Team Member 1 ____________________________________ Email __________________________________
Team Member 1 Address _____________________________________________________________________
Team Member 2 ____________________________________ Email __________________________________
Team Member 2 Address _____________________________________________________________________
Team Member 3 ____________________________________ Email __________________________________
Team Member 3 Address _____________________________________________________________________
Team Member 4 ____________________________________ Email __________________________________
Team Member 4 Address _____________________________________________________________________
Liability Release: As a participant in the Southern STARRS Scavenger “Fox” Hunt, I acknowledge the risks and potential for risks
involved in participating. I hereby, intending to be legally bound, for myself, my heirs and assignees, executors and administrators,
waive and release forever all claims for damages against Southern STARRS, its board of directors, volunteers, employees,
contributors, and/or participating businesses for any and all injuries and/or loses I may sustain while participating in the Southern
STARRS Scavenger “Fox” Hunt.
Date:________________________ Signature:_______________________________________
Date:________________________ Signature:_______________________________________
Date:________________________ Signature:_______________________________________
Date:________________________ Signature:_______________________________________
Mail to: Southern STARRS, 4050 Cairo Bend Rd, Lebanon, TN 37087 or email: southernstarrs00@gmail.com