RELEASE AND WAIVER OF LIABILITY
ASSUMPTION OF RISH AND INDEMNITY AGREEMENT
TRAIL-WAY SPORTS CLUB, INC.
DBA/ MOTORAMA ASSOCIATES AND TRAIL-WAY SPEEDWAY
(A) This Is A RACE LIABILITY RELEASE For Applicant Named
On Reverse Side Of This Form
(B) PLEASE READ THE FOLLOWING AND COMPLETE ALL NUMBERS.
(C) Complete 1 through 3 when applicant is OVER 18 years of age.
(D) Complete 1 through 7 when applicant is UNDER 18 years of age.
In consideration of being granted
an opportunity to race at any or all races sponsored by TRAIL-WAY SPORTS CLUB,
INC. DBA/ MOTORAMA ASSOCIATES, AND/OR TRAIL-WAY SPEEDWAY, I intend to
be legally bound hereby:
I, for myself, my heirs, personal representatives and assigns, HEREBY RELEASE , DISCHARGE AND AGREE TO HOLD HARMLESS AND INDEMNIFY TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA ASSOCIATES AND/OR TRAIL-WAY SPEEDWAY, the promoters, property owners, the participants in scheduled events, the owners, sponsors and manufacturers of all racing equipment upon the premises, and the officers, directors, officials representatives, agents and employees of all of them, OF AND FROM ALL LIABILITY, LOSS, CLAIMS, DEMANDS AND POSSIBLE CAUSES OF ACTION that may otherwise accrue FROM ANY LOSS, DAMAGE OR INJURY (INCLUDING DEATH) TO MY PERSON OR MY PROPERTY, in any way resulting from, or arising from, or arising in connection with, or related to, any scheduled event, and whether arising while engaged in competition or in practice or preparation therefore, or while upon, entering or departing from said premises, from any cause whatsoever including without limitation the failure of anyone to enforce rules and regulations, failure to make inspections, or the negligence of other persons. I KNOW THE RISK AND DANGER TO MYSELF AND PROPERTY while upon said premises or while participating or assisting in a scheduled event and I DO SO VOLUNTARILY AND IN RELIANCE, not upon property, equipment, facilities and existing conditions furnished by others,but UPON MY OWN JUDGMENT AND ABILITY, AND I HEREBY VOLUNTARILY AND KNOWINGLY ASSUME ALL RISK FOR LOSS, DAMAGE OR INJURY (INCLUDING DEATH) TO MYSELF AND MY PROPERTY from any cause whatsoever and whether or not attributable in whole or in part to the negligence of others.
I hereby certify that I assume all responsibility for all charges, premiums, and taxes, if any, payable on any funds that I may receive as a result of my competitive activities, including without limitation social security taxes, unemployment insurance taxes, compensation insurance, income taxes and withholding taxes.
I hereby make oath and say to the best of my knowledge and belief all statements set forth in this report are true and correct and I have read the above Liability Release.
........................................................................ *** MUST BE WITNESSED BELOW!! ***
(1) APPLICANT'S SIGNATURE (2) DATE OF BIRTH (3) WITNESS SIGNATURE
(TO BE COMPLETED IF APPLICANT IS UNDER 18 YEARS OF AGE)
I am the parent or legal guardian of (4)____________________________________________________
"PRINT APPLICANT'S NAME "
If married, I have the authority
of my spouse to sign this agreement as the spouse's agent and on the spouse's
behalf. I understand that my signature, under oath, may subject me to
penalties of perjury if any of the above statements are not true and correct.
In consideration of, and as inducement to TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA ASSOCIATES AND/OR TRAIL-WAY SPEEDWAY, permitting my child to enter the property and/or to participate in a racing event sponsored by TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA ASSOCIATES AND/OR TRAIL-WAY SPEEDWAY, I, for myself, my spouse (if married), my heirs, personal representatives and assigns do waive and release any and all damages and claims which I, or they may have against TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA ASSOCIATES AND/OR TRAIL-WAY SPEEDWAY and/or other leased property owners or any of them, their officers, directors or employees or by reason of any loss, damage or injury (including death) which may occur to applicant and further for myself, my heirs, personal representatives, assigns and my spouse (if married) I do agree to indemnity and save harmless TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA ASSOCIATES AND/OR TRAIL-WAY SPEEDWAY and/or other leased property owners, their heirs, successors and assigns, and their officers, directors, employees, sponsors and all others associated with the entry form any and all liability, loss claims, demands and possible causes of action that accure to myself, my spouse (if married), or the applicant by reason of participation in the event or entry upon the premises where the event is being held.
SEAL BELOW: (MUST BE NOTORIZED BY A NOTARY WITH A PARENT
MINOR UNDER 18 YEARS OLD)
AND SWORN TO BEFORE ME:
THIS______ DAY OF____________________, 20______
SIGNATURE OF PERSON ADMINISTERING OATH
|(6) I HAVE HEREUNTO
AFFIXED MY HAND & SEAL THIS______ DAY OF ________________, 20______
PRINT PARENT OR GUARDIAN'S SIGNATURE
PARENT OR GUARDIAN'S SIGNATURE