RELEASE    RELEASE    RELEASE    RELEASE    RELEASE

I herby release and agree to hold harmless the sponsors, the promoters, the owners, the leasee of premises, the participants, and officers, directors, officials, representatives, agents and employees of all of them, of and from all liability, loss, claims and demands that may occur from any loss, damage of injury (including death) to my person or property, in any way resulting from, or arising in connection with this event, and whether arising while engaged in competition or in practice or preparation thereof, or while upon, entering or departing from said premises, from any cause whatsoever. I know the risk and danger to myself and property while upon said premises or while participating or assisting in this event, so voluntarily in reliance, upon my own judgment and ability, and I thereby assume all risk for loss, damage or injury (including death) to myself and my property from any cause whatsoever. If participant is under age 18, this form must be signed by their Legal Guardian and/or Custodial Parent.

Official use only Bar Code Number:     Race/Event Date:

AMA #: AMA Exp Date:     AMA District #:     Club/Series #:

Last Name:, First Name: Middle:

Class: Class Fun 50 Race 50 65 85 JR 85 SR Open A (Money) Open B Open C +30 +50 Buddy     

Brand: Bike Size:cc     Model: Type: Motorcycle Quad Side by Side

Address:

City:     State:     Zip:

Birth Date:     Age:

Phone:

Sponsors:

E-Mail:

Legal Guardian Signature: ___________________________________________
                                                         (Legal Guardian and/or Custodial Parent MUST sign if participant is under 18)

Official use only
Total Amount: ________ Amount Paid: ________ Change Given: ________ Free Entry Approval: ______________

PLEASE FILL OUT THIS FORM, PRINT IT, SIGN IT, & BRING IT WITH YOU TO THE RACE.