2019 Trunk or Treat Registration Form First Name * Last Name * Address * Cell Phone * Home Phone * Vehicle Make * Vehicle Model * Vehicle Color * Vehicle License Plate Number * Proof of Vehicle Insurance * Files must be less than 2 MB.Allowed file types: jpg jpeg pdf. Proof of Vehicle Registration * Files must be less than 2 MB.Allowed file types: jpg jpeg pdf. Proof of Driver's License * Files must be less than 2 MB.Allowed file types: jpg jpeg pdf. Trunk or Treat Assumption of Risk, Waiver and Image Release * I acknowledge that my participation in this event, or that of my child could involve risk of physical injury or damage to property. I expressly assume such risk and release, and waive any claims against the Salem Volunteer Fire Company, Inc., its agents, and employees, for any injuries to persons or damage to property whether the result of negligence, breach of warranty or otherwise. I further agree to hold the Salem Volunteer Fire Company, Inc., its agents and employees harmless for any injury to persons or property damage caused by involvement in this activity except to the extent such claim might be based upon the sole and exclusive negligence of the Salem Volunteer Fire Company, Inc., its agents or employees. This Assumption, Waiver and Image Release form is effective and binding. I have read and understand this Assumption, Waiver and Image Release form. I also authorize the use of my name and picture and that of my child's to be released for use in the event coverage and promotion for future events. (If under 18 years of age, a parent or guardian must sign) Full Name (Signature) * By typing in your name, you acknowledge and understand the Trunk or Treat Assumption of Risk, Waiver and Image Release Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Leave this field blank