minor waiver

Transcript

1 PARENTAL CONSENT FORM/MINOR RELEASE FORM signatures REQUIRED for anyone under the age of 18 Both parent are pits at any SMI race track. to become an INEX/enter the ) **If parent( registration , th e minor s are not present at the time of work, signed MUST present this paper parent ( s ) , and by the absent notarized T hey must also attach a copy of the . birth minor’s certificate** Sole Custody / Guardianship : Court d ocumentation /o fficial paperwork is required in case of sole custody loss of a parent . Thi s does include d , / Divorce Settlement documents, Power of Attorney but is not limited to documentation, and Death Certificate s. **Minor waiver DOES NO T have to be notarized if the document is signed in front of a USLCI, INEX or SMI employee. ** NOT sign on behalf of any child over the age of six **Parents CAN years old** If you have any questions regarding the Pare ntal Consent Form/ Minor Waiver please call 704 - 455 - 3906 or email [email protected]

2 P A E N T A L C O N S E N T , R E L E A S E A N D W A I V E R O F L I A B I L I T Y , R S Y U M P T I O N O F R I S K , A N D I N D E M N I T A A G R E E M E N T S ) S C R I P T I O N A D D L O C A T I O N O F E V E N T ( S E N IN CONSIDERATION of my minor child (“the Minor”) being permitted to participate in any way in the EVENT(S) and/or being permitted to enter for any purpose any RESTRICTED AREA(S) (defined to be any area which requires special authorization, credentials or permission to enter or any area to which admission by the general public is restricted or prohibited), I agree: 1. I know the nature of the EVENT(S) and the Minor’s experience and capabilities, and believe the Minor to be qualified to participate in the Event(s). I will inspect the premises, facilities, and equipment to be used, or with which the Minor may come in contact. IF I OR THE MINOR BELIEVE ANYTHING IS UNSAFE, I WILL INSTRUCT THE MINOR TO IMMEDIATELY LEAVE THE RESTRICTED AREA AND REFUSE TO PARTICIPATE FURTHER IN THE EVENT(S). 2. I FULLY UNDERSTAND and will instruct the Minor that: (a) THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and participation in the Event(s) and/or entry into Restricted Areas involves RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“RISKS”); (b) these Risks and dangers may be caused by the Minor’s own actions, or inactions, the actions or inactions of others participating in the Event(s), the rules of the Event(s), the condition and layout of the premises and equipment, or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS NOT KNOWN TO ME or that are not readily foreseeable at this time; (d) THE SOCIAL AND ECONOMIC LOSSES and/or damages that could result from those Risk(s) COULD BE SEVERE AND COULD PERMANENTLY CHANGE THE MINOR’S FUTURE. 3. I consent to the Minor’s participation in the Event(s) and/or entry into restricted areas and HEREBY ACCEPT AND ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES, COSTS AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH, EVEN IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW. 4. I HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any Restricted Area, sponsors, advertisers, owners and lessees of premises used to conduct the Event(s), premises or event inspectors, surveyors, underwriters, consultants and other persons or entities who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities regarding the premises or Event(s) and each of them, their directors, officers, agents, employees, representatives, owners, members, affiliates, successors and assigns, all for the purposes herein referred to as “Releasees,” FROM ALL LIABILITY TO ME, THE MINOR, my and the minor’s personal representatives, assigns, heirs, and next of kin, FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON ACCOUNT OF ANY INJURY TO ME OR THE MINOR, including, but not limited to, death or damage to property, CAUSED OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE. 5. If, despite this release, I, the Minor, or anyone on the Minor’s behalf, makes a claim against any of the “Releasees” named above, I AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST THEY MAY INCUR DUE TO THE CLAIM MADE AGAINST ANY OF THE “RELEASEES” NAMED ABOVE, WHETHER THE CLAIM IS BASED ON THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. 6. I sign this agreement on my own behalf and on behalf of the Minor. I HAVE READ THIS PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I AND/OR THE MINOR WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES’ FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT. . A L L S E C T I O N S M U S T B E C O M P L E T E D V H A E S A E L E R I S I H T D A E R E r e : A . 1 P P L I C A N T L e g a l S i g n a t u Date: Applicant Printed Name: Affiliation: Date of Birth: A.D. 20 . day of before me this Subscribed and sworn to at E H A V E I S A E L E R S I H T D A E R e Date: : e r u t a n g S l a g L T N A C I L P P A . 2 i Applicant Printed Name: Date of Birth: Affiliation: before me this Subscribed and sworn to at day of A.D. 20 . Notary Public: Y R A T O County, N State of L My Commission Expires: A E S 1068NSX2 9/06

3 M I O R ’ S A S S U M P T I O N O F R I S K A N D R E L E A S E N N W A I V E R O F L I A B I L I T Y A D E S C R I P T I O N A N D L O C A T I O N O F E V D N T ( S ) D A T E R E L E A S E S I G N E E D I have obtained my parent’s consent to participate in the above event(s). I understand that I am assuming all of the risks if I get hurt during the event(s), and I state the following: Both my parents and I believe I am qualified to participate in the event(s). I will inspect the premises and equipment 1. and if, at any time, I feel anything to be unsafe, I will immediately leave and refuse to participate further in the event(s). 2. I understand that the ACTIVITIES OF THE EVENT ARE VERY DANGEROUS and INVOLVE RISKS AND DANGERS OF MY BEING SERIOUSLY INJURED OR HURT, MY BEING PARALYZED OR KILLED. 3. I know that these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the event(s), the rules of the event(s), the condition and layout of the premises and equipment, or the NEGLIGENCE of others, including those persons responsible for conducting the event(s). 4. I hereby assume all such risks, even if the risks are created by the of the promoters, participants, racing associations, NEGLIGENCE sanctioning organizations, or any of its subdivisions, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any restricted areas, promoters, sponsors, advertisers, owners, and lessees of premises used to conduct the events, premises or event inspectors, surveyors, underwriters, consultants, and any other person or entity who gives recommendations, directions, or instructions, or engages in risk evaluation, loss control activities or sales regarding the premises or events, and each of them, their officers and employees, all of which are referred to as “Releasees.” 5. I hereby release, waive, covenant not to sue, and discharge, all of the Releasees from all liability to me, my personal representatives, assigns, heirs, and next of kin, for any and all loss or damage and any claim or any demand on account of any injury to me including, but not limited to, my death, whether caused by the negligence of the Releasees or otherwise. I H A V E R E A D T H E A B O V E A S S U M P T I O N O F R I S K A N D R E L E A S E A N D W A I V E R O F L I A B I L I T Y , , U E R S T A N D W H A T I H A V E R E A D D A N D S I G N I T V O L U N T A R I L Y . N . A L L S E C T I O N S M U S T B E C O M P L E T E D E D A E R E V A H I T H I S R E L E A S g e Date: P L P I C A N T A r u t a n : i S l a g e L Applicant Printed Name: Date of Birth: Affiliation: A.D. 20 . day of before me this Subscribed and sworn to at Notary Public: County, Y R A T O N State of My Commission Expires: L A E S 1068NSX2 9/06

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