"Business Liability Wavier"
Event Date: AMA #: Expires: Name: Address: City: State: Zip: Age: D.O.B. Phone# E-Mail $20 Entry Fee Trophy Classes Class # Make Class # Make Class # Make 50cc 4-8 50 Jr 4-6 50 Sr 7-8 $25 Entry Fee Trophy Classes Class # Make Class # Make Class # Make Class # Make 65 Jr 7-9 Schoolboy 12-16 125cc Vintage 2002 older 65 Sr 10-11 Open B 14-24 4-Wheel B 85 Jr 9-11 Open C +30 B 4-Wheel C 85 Sr 12-15 250 B Girls 8-15 90cc 4-Wheel 8-15 Super Mini 12-16 250 C Women 12-up 300 4-Wheel 13-15 $25 Entry Fee Cash Payout Classes Class # Make Class # Make Class # Make Class # Make Open A +30 +50 4-Wheel A 250 A +40 +55 +25 +45 THIS IS A RELEASE AND INDEMINTY AGREEMENT - READ IT BEFORE SIGNING The UNDERSIGNED herby releases, waives, discharges and covenants not to sue the promoters,participants, racing associations, sanctioning organization's, MUDDY WATERS inc. or any subdivision therof, track operators, track owners, officials, vehicle owners, drivers, pit crew, rescue personnel, promoters, sponsors, advertisers, owners and leasees of premises used to conduct the EVENT (S) or daily business on premises and inspectors, surveyors, underwriters, consultants and others who give recommendations, directions, or instructions or engage in risk evaluation organization's, MUDDY WATERS inc. or any subdivision therof, track operators, track owners, officials, vehicle owners, drivers, pit crew, rescue loss control activites regarding the premises or EVENT(S) or daily business and each of them, their directors, officers, agents, and employees, all for the purpose herin referred to as "Releases", from all LIABILITYCLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENT(S) OR DAILY BUSINESS, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR THERWISE. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them from any loss, liability, damage or cost they may incur arising out of or related to the EVENT(S) or daily business whether caused by the negligence of the Releaseesor otherwise. THE UNDERSIGNED hereby assumes full responsibility for any risk of bodily injury, death or property damage arising out of or related to the EVENT(S) or daily business whether caused by the NEGLIGENCE OF RELEASEES or otherwise. I have read this Release and Wavier 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 with out any inducement, assurance or guarantee being made to me and extend my signature to be complete and unconditional release of all liability to the greatest extent allowed by law. (If participant is under age 18, his Parent or Legal Guardian must sign this form.) I FULLY UNDERSTSND THAT THERE IS NO RIDER MEDICAL INSURANCE PROVIDED. I UNDERSTAND MOTORCYCLE AND ATV RIDING IS DANGEROUS. FOR OFFICE USE ONLY YES, I HAVE READ THIS RELEASE Entry Fee: THIS IS A RELEASE Signature of Participant AMA Membership: THIS IS A RELEASE District Membership: Signature of Parent TOTAL: Minor Release Form District Staff Initials: