OFFICIAL ENTRY BLANK – CONTESTANT & PIT
CREW RELEASE FORM 2005
1.Date: _____________________ Show Location:
___________________________________________
2.Agreement:
In consideration for being allowed to participate or compete in the
Impact Motorsports LLC. Demolition Derby, the undersigned
Driver’s name
____________________________________________________________________
Street Address
____________________________________________________________________
City
_______________________________ State _______________Zip ___________
Agrees
to the following
3.Acknowledgment of Risk: The undersigned acknowledges
that the demolition derbies are dangerous activities and that the
participant in a demolition derby, as either a contestant, an
employee, or volunteer, exposes the participant to a substantial and
serious risk of property damage, personal injury or death. The
undersigned expressly acknowledges that his/her participation in the
demolition derby will involve such hazard.
4.Release of Sponsors:The undersigned, being fully
aware that participation in the demolition derby will expose him/her
to a substantial and serious risk of property damage and/or personal
injury or death, hereby release Impact Motorsports LLC. from liability
for any and all property damage, personal injuries or other claims
arising from the undersigned’s participation in the demolition derby
including those that are known and unknown, foreseen and unforeseen,
future or contingent.
5.Covenant Not to Sue:The undersigned covenants that
the undersigned shall not now or at any time in the future, directly
or indirectly, commence or prosecute any action, suit or other
proceeding against the sponsor ( or the officers, directors,
employees, agents or affiliates ) concerning, arising out of, or
related to the actions, causes of actions, claims and demands hereby
waived, released or discharged by the undersigned.
6.Assurances:The undersigned has
full power, authority, capacity, and right without limitations to
execute, deliver and perform this release.
7.Binding Effect:This release shall be binding upon
the undersigned and the undersigned’s spouse, legal representatives,
heirs, successors, and assigns.
8.I state that I have not carried in any alcoholic beverages.
This release has been carefully and fully read by the
undersigned and the undersigned fully understands its terms and
conditions and has voluntarily executed and delivered this release as
of the ____ day of _______2005
Age of Driver ________ Sign______________________________________ (Drivers Signature)
Note: DRIVERS
& PIT CREW 16 & 17 RELEASE AND CONSENT FORM
CONSENT
OF PARENT OF LEGAL GUARDIAN
I,
_____________________________________, have read the above release in
full, I fully understand it’s terms and conditions and I hereby
voluntarily execute and deliver this consent to
__________________________________ ‘s participation in the
demolition derby, I further agree to be fully bound by the release’s
terms and conditions in both my individual capacity as parent or legal
guardian for the undersigned. ____________________________________
(Signature of Parent or Legal Guardian)
Subscribed and sworn to this _________ day of _________________
A.D., 2005 Notary Public
__________________________________________________________________
County
My Commission expires
____________________________________________________