In submitting this entry, I herby for myself, my heirs, executors and administrators, waive any and all rights and claims for damages I may or hereafter have against individuals associated with Boy Scout Troop 178 in Waukee, Iowa, the city of Waukee, Iowa, Lutheran Church of Hope, and volunteers for any and all injuries suffered by me in said event.  I certify that I have full knowledge of the risks involved in this event and that I am physically fit and satisfactorily trained to participate in it and have no medical or physical conditions that prevent my participation in it.  I give my permission for the use of my name and picture in any broadcast, telecast, or print media account of this event.