Entry Title:________________________________________________________________________

I have read and understand the rules of the Costume-Con 25 Historical Masquerade and agree to 
abide by all of them. Further, I agree to permit photography and/or video recording and also agree 
to permit the use, sale, and/or dissemination of said photographs and/or video recordings subject to
permission from the Costume-Con 25 committee. 
Additionally, I agree to hold Costume-Con 25, its organizers, the facility, and all agents, assignees, 
and participants of Costume-Con 25, both severally and individually, blameless for any accident 
and/or injury suffered by me during the course of this Historical Masquerade, except in cases of 
gross negligence on the part of those cited above.

Date:____________________________
Print Name:_______________________ Signature:____________________________________

Release for Minor (all entrants under the age of 18) [if applicable].

I, being the parent/legal guardian of ________________________ [name of minor], on behalf 
of said minor, have read and understand the rules of the Costume-Con 25 Historical Masquerade 
and agree to abide by all of them. Further, I agree to permit photography and/or video recording 
and also agree to permit the use, sale, and/or dissemination of said photographs and/or video recordings 
subject to permission from the Costume-Con 25 committee. 
Additionally, I agree to hold Costume-Con 25, its organizers, the facility, and all agents, assignees, 
and participants of Costume-Con 25, both severally and individually, blameless for any accident 
and/or injury suffered by me during the course of this Historical Masquerade, except in cases of 
gross negligence on the part of those cited above.

Date: __________________________

Print Name:_____________________ Signature:____________________________________

Legal guardian of ______________________________

CONTACT INFORMATION (please print clearly)
Contact name:___________________________________ Phone:_______________
Street address:____________________________________________________________________
City: ____________________________________________________________________________
State/Province: ____ Postal [ZIP] Code: ____________ Country: ________

E-mail:___________________________________________________________________________