2015 Grape Stomp Application

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Fahrmeier’s Winey 2015 Grape Stomp Team Application

Saturday, September 26, 2015

All you have to do to enter a team is fill out this form, accident wavier and return with the $40 entry fee (pre-registration prior to September 15 guarantees you a place in the competition).  Make Check payable to Fahrmeier Family Winery. 

PLEASE PRINT – We must be able to read your writing!!

Name  ________________________________        Name ______________________________________


Address _______________________________       Address ____________________________________


City ________________________Zip_______        City______________________________Zip_______


_________________________________         ______________________________________________

Email Address (please print clearly)            Email Address (please print clearly)


We prefer to stomp at the following time. (Please check preferred time – You will be contacted to confirm time of your event.)


_______4:00 pm______5:00 pm ______ 6:00 pm_____ 7:00 pm

**Teams will be limited to 40 Teams. (grape harvest may limit participation)

Team Name (or organization you are representing): __________________________________

Method of Payment

Please check one

Check________ Amer Express _________ MasterCard _________ Visa ________ Discover_______

Card Number _______________________________________________________________________

Expiration Date: _______________________________ V-Code _______________________________

*The V-code is the last 3 digits of the number printed on the back of the credit card.

Signature ____________________________________________________________________________


Name (as it appears on the credit card) __________________________________________________


Billing Address ______________________________________________________________________


Phone ______________________________________________________________________________



2015 Fahrmeier’s Winey Grape Stomp - 9364 Mitchell Trail – Lexington, MO

Sni Valley Vineyards & Winery LLC dba Fahrmeier Family Vineyard and Winery


RELEASE AND WAIVER OF LIABILITY:  I hereby acknowledge that participation in a grape stomp is an inherently dangerous activity.  I understand that risks include serious injury or death, from such hazards as weather conditions, falls, contact with the road, contact with other participants, and other potential hazards.  I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury that may result from my participation in this Grape Stomp.  I further acknowledge that I should not enter or participate in this event unless I am medically able. 


For the sole consideration of allowing me to participate in this Grape Stomp, I hereby release and forever discharge Sni Valley Vineyards & Winery LLC, dba Fahrmeier Family Vineyard and Winery, LLC and its members, managers, agents, volunteers, contractors, employees, partner charities, and representatives from any and all claims, demands, rights, and causes of action arising from any personal injury, property damage, or the consequences thereof, resulting from or in any way connected with my participation in this activity.


PHOTOGRAPGHIC RELEASE:  I grant Sni Valley Vineyards & Winery LLC rights and license to use my name, my voice, my picture, or my likeness in photographic images and video or audio recordings made by Sni Valley Vineyards and Winery LLC and its agents during my participation in this grape stomp event or other account of these events for any purposes whatsoever.

SNI VALLEY VINEYARDS AND WINERY, LLC dba Fahrmeier Family Vineyards and Winery– LEXINGTON, MO and its agents reserve the right to reject any person and further reserve the right to change the details of this grape stomp without prior notice.  I understand that my participation fee is non-refundable and non-transferable.   

I certify that I am at least 18 years of age and

that I have read and understood the above.


I affirm that everything I say herein is true and correct.


_____________________________________                        _____________

Signature of Participant                                                           Date


If under the age 18 years then must have a parent’s permission and singature and that parent or guardian have read and understood the above.


I affirm that everything I say herein is true and correct.


____________________________________________                        _____________

                                    Signature of Participant’s parent or guardian                        Date



Printed Name:  ______________________________________________________


Address:                ______________________________________________________