Read MEADOW CREEK MOTOCROSS ENTRY FORM / LIABILITY WAIVER AND IDENTITY AGREEMENT text version

MEADOW CREEK MOTOCROSS ENTRY FORM / LIABILITY WAIVER AND IDENTITY AGREEMENT WITNESS_____________________

YOU MUST READ AND SIGN THE FOLLOWING RELEASE FORM:

I HEREBY GIVE UP ALL MY RIGHTS TO SUE OR MAKE ANY CLAIM FOR DAMAGES DUE TO NEGLIGENCE OR ANY OTHER REASON WHAT SO EVER AGAINST MEADOW CREEK MOTOCROSS, THE PROMOTERS, TRACK OWNERS, SPONSORS, EMPLOYEES AND ALL OTHER PERSONS, PARTICIPANTS, OR ORGANIZATIONS CONDUCTING OR CONNECTED WITH THIS EVENT FOR INJURY TO PROPERTY OR PERSON I MAY SUFFER, INCLUDING CRIPPLING INJURY OR DEATH, WHILE PARTICIPATING IN THE EVENT AND WHILE UPON EVENT PREMISES. I, MYSELF, MY PERSONAL REPRESENTATIVES, MY HEIRS, ANY MY NEXT TO KIN, ACKNOWLEDGE THAT MEADOW CREEK MOTOCROSS CANNOT ASSUME RESPONSIBILITY FOR ANY ASPECT OF MY SAFETY AND IF I PARTICIPATE IN ANY EVENT AT MEADOW CREEK MOTOCROSS I DO SO VOLUNTARILY ON MY OWN ASSESSMENT OF MY ABILITY, THE COURSE, AND ALL RELATED FACILITIES AND CONDITIONS. I UNDERSTAND THAT MY ENTRY FEE DOES NOT IN ANY WAY INCLUDE OR GUARANTEE ME TO ANY INSURANCE COVERAGE OF ANY KIND. I KNOW THE RISKS AND DANGER TO MYSELF AND MY PROPERTY WHILE PREPARING FOR AND PARTICIPATING IN THE EVENT AND WHILE UPON THE EVENT PREMISES AND RELYING UPON MY OWN JUDGEMENT AND ABILITY, I ASSUME ALL SUCH RISKS OF LOSS AND HEREBY AGREE TO REIMBURSE ALL COSTS TO THOSE PERSONS OR ORGANIZATIONS CONNECTED WITH THIS EVENT FOR DAMAGES INCURRED AS A RESULT OF MY NEGLIGENCE. I STATE THAT ALL THE ABOVE INFORMATION I HAVE PROVIDED TO MEADOW CREEK MOTOCROSS IS TRUE AND IF ANY INFORMATION HAS BEEN FALSIFIED OR DENIED MEADOW CREEK MOTOCROSS HAS THE RIGHT TO DISQUALIFY ME AT ANY TIME DURING THIS EVENT. IF ANY ALCOHOL OR DRUG USE IS DETECTED WHILE PARTICIPATING IN THIS EVENT, THE PROPER AUTHORITIES WILL BE NOTIFIED AND IS SUBJECT TO ARREST. I HAVE READ THE ABOVE RELEASE FORM AND FULLY UNDERSTAND NO REPRESENTATIVE OF MEADOW CREEK MOTOCROSS, THE PROMOTERS, THE TRACK OWNERS, THE SPONSORS, OR ANY PERSONS CONNECTED WITH THIS EVENT MAY VARY THE TERMS OR PROVISIONS OF THIS RELEASE FORM OR MAKE ANY REPRESENTATIONS CONTRARY TO THOSE LISTED ABOVE. SIGNATURE OF APPLICANT DATE

YOU MUST PRINT CLEARLY

AMA MEMBER ID:___________________ EXP DATE____/____

last first mi

NAME:___________________________________ 1ST CLASS NAME:_________________________ BIKE NUMBER:___________________________ BIKE BRAND:____________________________ MACHINE CC:____________________________ 2ND CLASS NAME:_________________________ BIKE NUMBER:___________________________ BIKE BRAND:____________________________ MACHINE CC:____________________________ ADDRESS:________________________________ ________________________________________ CITY:____________________________________ STATE:______________ZIP:_________________ BIRTH DATE:____/____/________ PHONE #: (_____)______-___________ EMAIL:___________________________________ SPONSORS:

___________________________________/____/___ SIGNATURE OF PARENT OR GUARDIAN REQUIRED FOR ALL APPLICANTS UNDER 18

TRACK USE ONLY Entered:___________ Review:_________ Other:_____________________________

__________________________________/____/____

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MEADOW CREEK MOTOCROSS ENTRY FORM / LIABILITY WAIVER AND IDENTITY AGREEMENT

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MEADOW CREEK MOTOCROSS ENTRY FORM / LIABILITY WAIVER AND IDENTITY AGREEMENT