2023 Escort Application Name(Required) First Middle Last Name Escort Goes By College/University Year Completed by May 30, 2023 High School Phone(Required)Email(Required) Parent(s) Name(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent's Phone(Required)Parent's Email(Required) Which Princess will you be escorting on the following nights?Friday (6/2) Saturday (6/3) Tuesday (6/6) Thursday (6/8) Friday (6/9) Escort Application Amount Price: Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Consent(Required) Do you agree to comply with all Rules & Regulations established by Carnival Memphis governing Royal Court members?Release and Indemnity Agreement In consideration of being permitted to participate in Carnival Memphis events and functions conducted by and/or in conjunction with the Great River Carnival Association , releasor, for himself, his legal representatives, heirs, and assigns, hereby forever releases, acquits and discharges the Great River Carnival Association, its directors, officers, employees, and members (hereinafter referred to collectively as “releasees”), from all liability, claims, causes of action, and demands which releasor may now or hereafter have for any injuries, damages, expenses, or losses of whatever kind, whether caused by the negligence of releasees or otherwise during or arising in any way from releasor’s participation in the events and functions aforementioned. Releasor agrees to indemnify the releasees for any loss, liability, damage or cost they may incur as a result of the actions of releasor during or arising in any way from releasor’s participation in the aforementioned events and functions. Releasor hereby assumes full responsibility for the risk of personal injury, property damage, and any and all other losses which releasor may sustain during or arising in any way from releasor’s participation in the aforementioned events and functions. Releasor expressly agrees that this Release and Indemnity Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Tennessee, which laws shall apply to the construction of this agreement, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. In witness whereof, releasor has executed this Release and Indemnity Agreement on the day and year written below.Escort Signature(Required) First Last Parent Signature(Required) First Last Date(Required) MM slash DD slash YYYY CAPTCHA