First Responder Registration

Department Name:*

Head Cook:*

Address:*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Phone:*

Area Code

-

Phone Number

E-mail:*

Cooking Space Dimensions:*

Charity Name:*

Please indicate your willingness to participate in the steak and sausage challenge:*

Click here for details regarding the Kennie's Steak and Sausage Challenge.

Additional Requirements:

Word Verification:

By clicking submit the undersigned does hereby discharge, release, indemnify, and hold harmless the Borough of Spring Grove, Spring Grove Regional Parks and Recreation and the Spring Grove Chamber of Commerce its officers, employees, agents, volunteers, and all other sponsoring organizations from any and all manner of actions, suits, damages or claims whatsoever arising from any loss or damage to the person or property of the undersigned and the undersigned's employees, volunteers, representatives or agents while participating in the SMOKE IN THE GROVE event.

Total:

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