2025 Power Wheels Derby Registration

Personal Information

First Name

Last Name

Email Address

Sign up for email updates from Benton Franklin Fair Association

Address Line 1

Address Line 2

City

State

Postal Code

Phone Number

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
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Driver info

Driver Name

Provide child's name

Driver Age

Parent Name

Parent Address

Parent Phone

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