PLEASE PRINT CLEARLY

NAME            ____________________________________________________________
ADDRESS     ____________________________EMAIL_________________________

CITY               ______________________   STATE__________ZIP________________

PHONE          _____________________ D.O.B___________   AGE________________

BIKE NUMBER __________ BRAND ____________ SIZE _____________________

$30.00 per class (Use new form for each additional class if bike and/or number is different in additional class)
 

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

I HEREBY RELEASE, DISCHAGRE AND COVENANT NOT TO SUE the promoter, participants, racing associations, sanctioning originations or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any Restricted Area, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the Event(s), premises or event inspectors, surveyors, underwriters, consultants and other persons or entities who give recommendations, directions, or  instructions or engage in risk evaluation or loss control activities regarding the premises or Event(s) and each of them, their directors, officers agents, and employees, all for the purpose herein referred to as “Release”,  FROM ALL LIABILITY TO ME, THE MINOR, my and minors personal representatives, assigns, heirs, and next of kin, FOR ANY AND ALL CLAMIS, DEMANDS, LOSSES, OR DAMAGES ON ACCOUNT OF ANY INJURY, including , but not limited to, death or damage to property, CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE.

I have read this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and voluntarily without any inducement, assurance, or guarantee being make to me and extend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. (IF PARTICIPANT IS UNDER AGE 18, FRONT AND BACK OF THIS FORM MUST BE SIGNED BY HIS PARENT OR LEGAL GAURDIAN)

I FULLY UNDERSTAND THAT THERE IS NO RIDER MEDICAL INSURANCE PROVIDED

I UNDERSTAND MOTORCYCLE RACING IS DANGEROUS

YES, I HAVE READ THIS RELEASE

RIDERS NAME____________________________________________________________________

PARENT OR LEGAL GUARDIAN’S SIGNATURE_____________________________________

DATE_______________________________________