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.
NOTARY
SEAL BELOW: (MUST BE NOTORIZED BY A NOTARY WITH A PARENT
FOR ANY
MINOR
UNDER 18 YEARS OLD)
(5) SUBSCRIBED
AND SWORN TO BEFORE ME: THIS______ DAY OF____________________, 20______ SIGNATURE OF PERSON ADMINISTERING OATH __________________________________________________ S |
(6) I HAVE HEREUNTO
AFFIXED MY HAND & SEAL THIS______ DAY OF ________________, 20______
PRINT PARENT OR GUARDIAN'S SIGNATURE ___________________________________________________ PARENT OR GUARDIAN'S SIGNATURE (7)_________________________________________________ |