2009 ALBERTA OLDTIMERS Moto-X ENTRY FORM
NAME: _______________ ADDRESS: Province/State: Phone #: ( ) Postal/Zip Code: e-mail: . Model: : Displ: cc 2-Stroke: 4-Stroke: . @ Birth date: City: . . AGE: . .
AOTMX Membership #: BIKE: Make:
Put your Bike # in the box below that matches your class:
Classes:
GROUP:
SKILL LEVEL
NOVICE AMATEUR EXPERT MASTER
70+ 60+ 50+ 40+ 30+ U-30 Ladies Mini
N/A
* A new form MUST be filled out for each class entered in.
This section for use by AOTMX staff
Entry Fee: $__________ Paid By: Chq #_______
N/A N/A
85cc
Cash_______
B
65cc
A
N/A N/A
Note: All riders under the age of 25 MUST have a parent or legal guardian who is a current AOTMX member: Member info and signature to be filled out below: AOTMX member name: Member signature: ________________________________
ASSUMED RISK WAIVER This waiver must be read and signed by each rider
I hereby acknowledge that I am aware of the dangers incident to motorcycle riding and knowingly enter the events with said knowledge. I further acknowledge the risk of injury or death to my personal property while participating in, or watching motorcycling events and am aware that injuries sustained by me could be of a permanent or grave nature and I, nevertheless, voluntarily and knowingly enter said events. I further acknowledge that during the course of said events, there may be times that which, though not actively participating in said event, I may be a spectator or maybe called upon to provide organizational assistance at trackside and that I may sustain permanent or grave injuries as a spectator or volunteer, and I, nevertheless voluntarily and knowingly assume such risk. I further acknowledge that I may sustain permanent or grave injuries as either a participant or spectator at these events due to the negligence of other persons including participants, The Alberta Oldtimers Motocross Association and its members, the Landowner or other spectators and with that in mind and nevertheless, voluntarily and knowingly assume such risk. I further agree that I will not sue or make any claims against the other Participants, Spectators, the Landowners, the Alberta Oldtimers Motocross Association and its members whatsoever, no matter what injuries I may sustain as either a participant or spectator.
Membership #:_________
I HAVE READ THE ASSUMED RISK WAIVER AND AGREE TO THE ABOVE CONDITIONS. Signature: Date: At: RELEASE AND INDEMNITY FOR MINORS ON BACK OF ENTRY FORM (Completed by Parent/Guardian)
RELEASE AND INDEMNITY FOR MINORS
(Must be completed by Parent or Guardian)
WHEREAS, ___________________________ (hereinafter called the "Participant") desires to compete in Alberta Oldtimers' Motocross Association (hereinafter called the "AOTMX") sanctioned motorcycle event; AND WHEREAS, the Participant is a minor; AND WHEREAS, the undersigned is/are the parent(s) or legal guardian(s) of the Participant (hereinafter called the "Parents"); AND WHEREAS, the Parents have requested that, despite the tender years of the Participant; the Participant be permitted to compete in AOTMX/CMRC sanctioned motorcycle events; AND WHEREAS, the AOTMX is unwilling to allow the Participant to compete in sanctioned motorcycle events unless the Parents agree to assume full responsibility for any loss, injury damage or death which the Participant might sustain while participating in the event(s); AND WHEREAS, in consideration of the covenants to the part of the Parents hereinafter contained, the AOTMX has agreed to permit the Participant to compete in AOTMX sanctioned motorcycle events provided that he or she otherwise qualifies for said competition and subject to the By-laws, rules and regulations of the AOTMX; WITNESSETH that in consideration of other good and valuable consideration and the covenants herein contained: The Parents covenant and agree: 1. To remise, release, and forever discharge for the AOTMX and/or CMRC of and from all manner of actions, cause of action, suits, claims and demands of whatsoever nature or kind which the Parents ever had, now have or which the Parents, their heirs, executors, and administrators, successors and assigns, or any of them, hereinafter can, shall or may have for or by reason of the death or injury, damage or loss to the Participant or the Parents arising out of or in any way attributable to the Participant's competing in AOTMX sanctioned motorcycle events. 2. To indemnify and save harmless the AOTMX against and from all actions, causes of action, damages, suits, claims and demands of whatsoever nature or kind (including legal costs incurred in respect thereto) in respect of, or arising out of, the Participant's competing in AOTMX sanctioned motorcycle events, which against the AOTMX the Participant ever had, now has or which the Participant, their heirs, executors, and administrators, successors and assigns, or any of them, hereinafter can, shall or may have and which may hereinafter by brought against the AOTMX by or on behalf of the Participant, his heirs, executors, administrators, successors and assigns, and any of them. 3. To indemnify and save harmless the AOTMX against and from all action, causes of action, damages, suits, claims and demands whatsoever of every nature and kind, (including legal costs incurred in respect thereto) which any other Participant in an AOTMX sanctioned event can, shall or may have, or their heirs, executors, and administrators, successors and assigns can, shall or may have and which may hereinafter by brought as against the AOTMX by said Participant, by his heirs, executors, administrators, successors or assigns, or any one on his behalf, by reason of the Participant's competing in said event or events. 4. Not to take action or bring any proceedings arising out of or in any way connected with the Participant's competing in AOTMX sanctioned motorcycle events against any other person or corporation which might claim contribution or indemnity from the AOTMX. 5. The terms hereof shall be binding upon the Parents notwithstanding that the death or injury, damage or loss to the Participant or caused by the Participant may have been caused or contributed to by the negligence of the AOTMX. 6. The term "AOTMX" as used herein shall include the Alberta Oldtimers Motocross Association, its Members, Officers, Directors, Servants, Agents, Event Officials, Sponsors, Affiliates, and each of their respective heirs, executors, administrators, successors, assigns, agents, officers, servants and representatives. 7. The terms hereof shall be binding upon the undersigned as well as the respective heirs, executors, administrators, successors and assigns. 8. The terms hereof importing the singular number or the masculine gender shall include the plural number or the feminine gender as the case may be.
IN WITNESS WHEREOF the Parents have hereunto affixed their hands and seals on the
day of ,
,2009
SIGNED
.
(SIGNATURE OF PARENT/GUARDIAN)
.
(RELATIONSHIP TO APPLICANT)