EmailMeForm
2024 Event Membership Application
POWRi Quarter Midget Racing League
Proof of a current membership with a sanctioned quarter midget racing association will be required in order to participate.
Event Membership Fee $20.00
You will be redirected to another site to pay your POWRi fee.
Event Membership gives you no voting rights in POWRi or at the club level.
Choose all that apply
Membership
*
Please select
Event Membership Only
Membership Type
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Event Membership
Event Membership - This event membership application only allows you to race at this event only.
You will need to purchase an event form for each event that you are planning on racing if you are not a POWRi member.
Member Information
Please use no abbreviations,Incomplete applications WILL NOT be processed
Handlers Name
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First
Middle
Last
Spouse Name
First
Middle
Last
Handlers Birthdate
*
MM
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DD
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YYYY
Spouse Birthdate
MM
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DD
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YYYY
Handlers Phone
*
###
-
###
-
####
Spouse Phone
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-
###
-
####
Handlers Email
*
Spouse Email
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Club you are participating at
*
Please select
Tri - Valley
Valley of the Sun
Event Date
MM
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DD
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YYYY
Children/Drivers Information
All Information must be complete to process
#1 Child's Name
First
MI
Last
Birthdate
MM
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DD
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YYYY
Novice/Non Driver (Any child new to the sport or has not completed Training)
Please select
Novice
Non Driver
No
#2 Child's Name
First
MI
Last
Birthdate
MM
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DD
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YYYY
Novice/Non Driver (Any child new to the sport or has not completed Training)
Please select
Novice
No
Non Driver
#3 Child'sName
First
MI
Last
Birthdate
MM
/
DD
/
YYYY
Novice/Non Driver (Any child new to the sport or has not completed Training)
Please select
Novice
No
Non Driver
#4 Child's Name
First
MI
Last
Birthdate
MM
/
DD
/
YYYY
Novice/Non Driver (Any child new to the sport or has not completed Training)
Please select
Novice
No
Non Driver
Event Membership Terms and Conditions,Acknowledgements,Convenants and Representations
The following includes,without limitation,requirements,terms,and conditions to membership in the POWRi Quarter Midget League. By applying for and accepting membership in POWRi Quarter Midget League,each individual as part of an individual or family membership,on his or her own behalf and on behalf of any of his or her minor participants,and on behalf of their personal representatives,heirs,and next of kin(hereinafter collectively the "UNDERSIGNED") hereby:
1. Acknowledges and accepts that all drivers in POWRi Quarter Racing League sanctioned events must be registered with POWRi, and they must be under the age of eighteen (18). - 2. Understands that those drivers initially becoming members,the application should specifically indicate which drivers have no prior driving experience,designating them as "Novice" drivers. - 3. Understands that individual members of POWRi completing their own application must be eighteen (18) years of age or older. All individuals under the age of eighteen (18) must be registered member as part of a membership application completed and submitted by his or her parent/legal guardian. - 4. Understands that any individual between the age of eighteen(18) and twenty(21) years of age that continues to live at home with parents members of the POWRi may remain on the parents application as a "Alternate Handler". Once and individual turns twenty one (21) years of age or once he or she lives outside the parents home,they must join POWRi Quarter Midget Racing League as an individual member (as opposed to as part of a family membership). - 5. Accepts that parents or legal guardians (who have fifty percent (50%) or more legal custody as evidenced by official court or government documents) must complete a family membership application for all drivers under the age of eighteen(18) in their immediate family that participate in POWRi sanctioned events.If a driver in the immediate family has a different surname from the parent or legal guardian, the parent or legal guardian is required to submit a written letter explaining the circumstances upon the request of difference in surname, and, he or she will submit or supporting documentation evidencing said circumstances upon the request of POWRi. - 6. Understands that a single individual over the age of eighteen (18) may apply for the position of "Alternate Handler," and that neither couples nor drivers may apply for such membership. "Alternate Handlers" do not have any POWRi voting privileges. - 7. Understands that all individual or family memberships seeking to participate in a event sanctioned by POWRi Quarter Midget Racing League must be a member of good standing with a Charter Club affiliated with POWRi. POWRi Charter Clubs are required to submit an approval list to the POWRi Quarter Midgets Racing League Secretary as to each member that has been accepted to that Charter Club within fifteen (15) days of submission of members application. - 8. Understands that incomplete applications and membership documentation will not be processed and will be returned . - 9. Certifies that the information, warranties, and representations set forth in this application and all membership documentation submitted in support of this application is true and accurate, and acknowledges that the POWRi may and will rely upon such information in processing the membership application and considering UNDERSIGNED for membership. - 10. Applies for an annual "Family" or "Alternate Handler" membership in the POWRi of the type of specified in this application. UNDERSIGNED understands that "Family " membership is individual and treated as a collective whole. The terms and conditions and requirements of "Family" membership and all rules,regulations,guidelines,and codes of conduct of POWRi apply to each and every member of the family as described in application. UNDERSIGNED understands and acknowledges that any violation or improper conduct as to any individual of the "Family " membership shall be treated as a violation or improper conduct on the part of the "Family" as a whole, and UNDERSIGNED expressly understands and accepts that any disciplinary action issued by the POWRi will be issued against the "Family" as a whole. - 11. Acknowledges,understands and accepts that memberships in the POWRi is subject to the by-laws, rules , regulations,guidelines, and code of conduct (hereinafter, collectively the "RULES") of the POWRi as may be published and updated/revised from time to time in its discretion. UNDERSIGNED acknowledges that he/she has reviewed, accepted, and understood all applicable POWRi and Charter Club Rules and UNDERSIGNED agrees to be bound by all such provisions and obligations. UNDERSIGNED accepts responsibility to remain familiar with all applicable RULES and to explain and inform all other members of the "FAMILY" of such RULES. UNDERSIGNED understands the he/she may obtain copies of any National RULES by sending a written request to the POWRi Quarter Midget Racing League Secretary (809 E Washington, Riverton,IL 62561), and that he/she may also obtain a copy of his/her local Charter Club(s) RULES by sending a written request to the Charter Club's Board of Directors. - 12. Acknowledges ,understands and accepts that the POWRi Board of Directors, the Executive Committee,and local Charter Club Board of Directors shall be the sole and final arbiter of all issues involved the membership application or other documentation, membership in the POWRi,participation in POWRi sanctioned events and activities, and/or interpretation or application of the national, regional, and/or local Charter Club RULES. UNDERSIGNED agrees to be bound by and to comply with the administrative review process and all appeal procedures as set forth in the forth in the RULES. UNDERSIGNED agrees that he/she will not to file any lawsuit or assert any claim (in law or equity) against the POWRi and/or any of its directors, officers, officials, employees,members ,facility operators and owners,lessors, or lessees (hereinafter "RELEASEES") relating to this application or other membership documentation ,his/her membership ,his /her participation in the events, and/or the interpretation of application of the RULES. In the event that any UNDERSIGNED or any member listed application files a lawsuit against and/or asserts a claim against RELEASEES, UNDERSIGNED agrees to defend,indemnify and hold the RELEASEES harmless from any and all damage, costs, and/or expenses incurred by RELEASEES in connection with said lawsuit and/or claim, including reasonable attorney's fees and court costs. - 13. Acknowledges and agrees that he or she does not have the right to be a member in the POWRi and that membership is a privilege. UNDERSIGNED accepts that POWRi has the right and ability, at any time and in its sole discretion, to condition or suspend all memberships to the POWRi, and that it may terminate or revoke membership upon the tender of all membership dues paid by the member in for the current membership year. UNDERSIGNED understands that all action taken by POWRi with regard to this membership applies to a "FAMILY" membership on the whole, regardless of whether or not any individual with in the Family membership was responsible for or involved in any violation of conduct leading to such action. - 14. Grants to POWRi, and/or its assigns, the right to use, exploit,and publicize the names,likenesses,images, and names of everyone on this application in connection with the POWRi and POWRi sanctioned events and activities on a non- exclusive and royalty free basis in any and all forms of media for any and all purposes, including the promotion and marketing of POWRi and its events, except for the commercial endorsement of any product. - 15..Accepts and acknowledges that this application is dependent upon, and membership in the POWRi is conditioned upon, the completion and execution of a "Waiver and Release, Express Assumption of the Risk, Indemnity and Voluntary Consent Agreement" (hereinafter "RELEASE") by each and every individual that is part of the membership application and submission. UNDERSIGNED understands and agrees that the POWRi must receive a valid and fully completed and executed separate RELEASE from each and every minor and adult included in the membership application. Every adult applicant (individuals over the age of eighteen (18) is required to complete and submit an Adult RELEASE, while the parent(s) or legal guardian(s) of each minor applicant (individuals under the age of eighteen (18) is required to complete a "Minor" RELEASE on behalf of the minor. POWRi's "Adult" and "Minor" RELEASES are incorporated herein by reference.
Please read Adult Waiver information located in the box below and each Adult must Sign in the box below
2024 ADULT ANNUAL MEMBERSHIP RELEASE AND WAIVER OF LIABILITY EXPRESS ASSUMPTION OF RISK,VOLUNTARY CONSENT AND INDEMNITY AGREEMENT -------------- THIS AGREEMENT MUST BE CAREFULLY READ AND SIGNED IN CONSIDERATION OF my ability to become a 2024 member of POWRI Quarter Midget Racing League(hereinafter the"POWRI")and to participate in any and all motor racing events sanctioned,promoted,and/or operated by the POWRI at any and all facilities through out the 2024 season(January 1,2024 through December 31, 2024)and any and all affiliated activities including ,without limitation, driving, racing, training, learning, practicing, competing, maintaining vehicle observing and spectating,or for any other purpose(hereinafter collectively "EVENTS') and/or IN CONSIDERATION OF my ability to enter into or upon any RESTRICTED AREA (hereinafter defined as including,but not limited to, the racing track and surface, pit area, infield, paddock and garage area,grandstand area,and all walkways,concessions,and other area appurtenant to any area where any activity related to the EVENTS are or will be taking place). The undersigned,on behalf of himself/herself, his/her personal representative,heirs,and next of kin(hereinafter collectively "UNDERSIGNED") hereby: - 1. INSPECTION Acknowledges, agrees and represents that immediately upon entering any RESTRICTED AREA,the undersigned shall and shall continuously thereafter, inspect every area of the RESTRICTED AREA which the UNDERSIGNED enters,and the UNDERSIGNED further agrees and warrants that , if at any time, the UNDERSIGNED is in or about any part of the RESTRICTED AREA and feels anything to be unsafe, the UNDERSIGNED will immediately advise a representative, employee or agent of POWRI and the owner or operator of the RESTRICTED AREA and/or refuse to participate in the EVENTS. - 2. WAIVER AND RELEASE : Hereby RELEASE,WAIVES,DISCHARGES AND COVENANTS NOT TO SUE the POWRI,the operators,organizers,sponsors, and hosts of the EVENTS,officials,rescue personnel, the track and facility and location owners,lessors,leasees,inspectors,surveyors, underwriters,consultants and others who give recommendations,directions,or instructions or engage in risk evaluation or loss control activities regarding the track,facility and location, and each of their affiliated owners, subsidiaries, shareholders,officers,directors,managing agents, employees,independent contractors,members, agents,attorneys, investors,assigns,affiliated organizations and entities, and all other persons or entities participating or involved in the EVENTS (hereinafter collectively "RELEASEES" ) , FROM ALL LIABILITY to the UNDERSIGNED for any and all loss or damage and any claim or demands therefore and account of INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH of the UNDERSIGNED arising out of or related to the UNDERSIGNED's participation in any way in the EVENTS and/or the UNDERSIGNED's presence in or upon the RESTRICTED AREA where the EVENTS are or will be taking place,even that caused by the ordinary NEGLIGENCE of the RELEASEES (hereinafter "LIABILITY"). The LIABILITY encompasses. but is not limited to, active or passive conduct,ordinary NEGLIGENT RESCUE EFFORTS, and ordinary NEGLIGENT enforcement of (or the failure to enact or enforce) rules, regulations and guidelines. It also encompasses, without limitation,LIABILITY concerning the ordinary NEGLIGENT selection,use,operation, design and/or maintenance of any equipment ., facility, location, or service related to the EVENTS. - 3. MEDICAL CONSENT AND RELEASE: Hereby specifically AUTHORIZES AND CONSENTS TO RELEASEES providing and/or arrange for MEDICAL CARE OR TREATMENT OR EMERGENCY MEDICAL SERVICES OR RESCUE EFFORTS in the event of an emergency or in the event of an injury or medical condition that develops or occurs during participation in the EVENTS or during the UNDERSIGNED's presence in or upon the premises, facilities, and locations where the EVENTS are or will be taking place. UNDERSIGNED expressly WAIVES AND RELEASES AND AGREES TO HOLD RELEASEES HARMLESS from and against any and all LIABILITY arising therefrom. - 4. EXPRESS ASSUMPTION RISK : Hereby acknowledges the ACTIVITIES can be EXTREMELY DANGEROUS and involve the RISK OF SERIOUS INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE. This agreement also constitutes an express and contractual ASSUMPTION OF ALL RISKS AND DANGERS associated with the EVENTS, which include,but not limited to,the risk of being struck by objects or equipment and/or making contact with or colliding with other participants,spectators, other persons, and natural or man made objects. The EVENTS will include participants of all skill and experience levels (including both professional and amateur persons) and varying levels of equipment, and UNDERSIGNED expressly assumes the risks associated with mixed and varying skill levels and varying equipment, UNDERSIGNED also acknowledges that there may be undefined and presently unknown risks and dangers associated with the EVENTS, and that there may be risks and dangers that may result from the ordinary NEGLIGENCE of the RELEASEES. This includes the potential ordinary NEGLIGENCE in the selection,use,operation,design, or maintenance of any equipment, course, competition , facility or service related to the EVENTS, UNDERSIGNED hereby expressly assumes all such risks and dangers whether presently known or unknown. The UNDERSIGNED ,also expressly acknowledges that injures received may be compounded or increased by ordinary NEGLIGENT RESCUE OPERATIONS OR PROCEDURES of the RELEASEES or others. - 5. INDEMNITY AND HOLD HARMLESS : Hereby agrees to DEFEND,INDEMNIFY, AND SAVE AND HOLD HARMLESS the RELEASEES and each of them from any loss,liability,damage, or cost (including attorneys' fees and court cost) they may incur arising out of or related to the UNDERSIGNED's presences in or upon the RESTRICTED AREA where the events are or will be taking place, whether cause by ordinary NEGLIGENCE , of the RELEASEES or otherwise. UNDERSIGNED also hereby agrees to DEFEND, INDEMNIFY,AND SAVE AND HOLD HARMLESS the RELEASEES from any loss , liability, damage or cost (including attorney's fees and court costs) caused by or arising out of any action or failure to act by UNDERSIGNED during or in connection with UNDERSIGNED's participation in EVENTS, and/ or arising out or UNDERSIGNED's improper,tortuous, and/or criminal conduct. - 6. INFORMED CONSENT AND VOLUNTARY PARTICIPATION : Fully acknowledges and understand that participation in the EVENTS will involve physical and strenuous activity and dangerous and changing circumstances and conditions. UNDERSIGNED HAS taken it upon himself or herself to be fully informed of the numerous inherent risks and potential dangers associated with EVENTS, including the RISK OF BEING INVOLVED IN AN ACCIDENT, CRASH OR COLLISION, AND SUFFERING SEVERE PERSONAL INJURY OR DEATH. UNDERSIGNED acknowledges that he or she has been able to ask questions regarding the EVENTS, and that all questions have been satisfactorily answered. - 7. OTHER PARTICIPANT OBLIGATIONS: Acknowledges that it is his or her responsibility to do all of the following (1) fully disclose the RELEASEES any health issues or medications that are relevant to participation in the EVENTS: (2) inform RELEASEES if there are any activities or aspects of the program about which the UNDERSIGNED does not feel comfortable: (3) cease participation and promptly report any physical discomfort, illness or complications: and (4) clear his or her participation with his or her personal physician. UNDERSIGNED also acknowledges the he or she bears full responsibility to become aware of and familiar with any and all event ,series,and facility rules,regulations,and instructions, and to follow such rules, regulation and instructions. - 8. Hereby agrees that his Agreement extends to ALL ACTS OF ORDINARY NEGLIGENCE by the RELEASEES, including premises liability and NEGLIGENT RESCUE OPERATIONS ,and it is intended to be as broad and inclusive as permitted by law. UNDERSIGNED acknowledges that THIS AGREEMENT IS INTENDED TO BE FULLY SEVERABLE, and that if any portion of this agreement is held invalid, it is agreed that the balance the agreement shall continue in full legal force and effect. That shall include modifying the agreement to allow the remainder of claims to be waived, released,and indemnified against in the event that the inclusion of any particular type of claim is found to be invalid or contrary to public policy. This Agreement is to be interpreted and enforced under the law of the State of Illinois. - 9. Hereby accepts all terms set forth herein and acknowledges this is the complete agreement between the parties regarding these issues, and UNDERSIGNED agrees and acknowledges that NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS HAVE BEEN MADE APART FROM THIS AGREEMENT. UNDERSIGNED HAS COMPLETELY READ BOTH PAGES OF THIS AGREEMENT, FULLY UNDERSTANDS ITS TERMS, AND UNDERSTANDS THAT THIS IS AN IMPORTANT LEGAL DOCUMENT AFFECTING SUBSTANTIAL LEGAL RIGHTS. UNDERSIGNED SIGNS THIS DOCUMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO HIM OR HER AND UNDERSIGNED INTENDS HIS OR HER SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. UNDERSIGNED was given ample opportunity to read the agreement and/or have it reviewed by legal counsel of his or her choice. UNDERSIGNED was also offered a copy of this Agreement.
I agree by electronically signing to the above insurance requirements
Handler Electronic Signature
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Spouse Electronic Signature
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Please read the Minor Annual Membership Release and Waiver of Liability form below. You must sign each minors name below that you have listed on this Application.
2024 MINOR ANNUAL MEMBERSHIP RELEASE AND WAIVER OF LIABILITY - EXPRESS ASSUMPTION OF RISK, VOLUNTARY CONSENT AND INDEMNITY AGREEMENT - - THIS AGREEMENT MUST BE CAREFULLY READ AND SIGNED IN CONSIDERATION OF my and my minor child's ability to become a 2024 member of POWRI Quarter Midget Racing League (hereinafter the"POWRI")and to participate in any and all motor racing events sanctioned,promoted,and/or operated by the POWRI at any and all facilities through out the 2024 season(January 1,2024 through December 31, 2024)and any and all affiliated activities including ,without limitation, driving, racing, training, learning, practicing, competing, maintaining vehicle observing and spectating,or for any other purpose(hereinafter collectively "EVENTS') and/or IN CONSIDERATION OF my and my minor child's ability to enter into or upon any RESTRICTED AREA (hereinafter defined as including,but not limited to, the racing track and surface, pit area, infield, paddock and garage area,grandstand area,and all walkways,concessions,and other area appurtenant to any area where any activity related to the EVENTS are or will be taking place). The undersigned,on behalf of himself/herself, and on behalf of his minor participating child,and their personal representative ,heirs,and next of kin(hereinafter collectively "UNDERSIGNED") hereby: - 1. INSPECTION Acknowledges, agrees and represents that immediately upon entering any RESTRICTED AREA,the undersigned shall and shall continuously thereafter, inspect every area of the RESTRICTED AREA which the UNDERSIGNED enters,and the UNDERSIGNED further agrees and warrants that , if at any time, the UNDERSIGNED is in or about any part of the RESTRICTED AREA and feels anything to be unsafe, the UNDERSIGNED will immediately advise a representative, employee or agent of POWRI and the owner or operator of the RESTRICTED AREA and/or refuse to participate in the EVENTS. - 2. WAIVER AND RELEASE : Hereby RELEASE,WAIVES,DISCHARGES AND COVENANTS NOT TO SUE the POWRI,the operators,organizers,sponsors, and hosts of the EVENTS,officials,rescue personnel, the track and facility and location owners,lessors,leasees,inspectors,surveyors, underwriters,consultants and others who give recommendations,directions,or instructions or engage in risk evaluation or loss control activities regarding the track,facility and location, and each of their affiliated owners, subsidiaries, shareholders,officers,directors,managing agents, employees,independent contractors,members, agents,attorneys, investors,assigns,affiliated organizations and entities, and all other persons or entities participating or involved in the EVENTS (hereinafter collectively "RELEASEES" ) , FROM ALL LIABILITY to the UNDERSIGNED for any and all loss or damage and any claim or demands therefore and account of INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH of the UNDERSIGNED arising out of or related to the UNDERSIGNED's participation in any way in the EVENTS and/or the UNDERSIGNED's presence in or upon the RESTRICTED AREA where the EVENTS are or will be taking place,even that caused by the ordinary NEGLIGENCE of the RELEASEES (hereinafter "LIABILITY"). The LIABILITY encompasses. but is not limited to, active or passive conduct,ordinary NEGLIGENT RESCUE EFFORTS, and ordinary NEGLIGENT enforcement of (or the failure to enact or enforce) rules, regulations and guidelines. It also encompasses, without limitation,LIABILITY concerning the ordinary NEGLIGENT selection,use,operation, design and/or maintenance of any equipment ., facility, location, or service related to the EVENTS. - 3. MEDICAL CONSENT AND RELEASE: Hereby specifically AUTHORIZES AND CONSENTS TO RELEASEES providing and/or arrange for MEDICAL CARE OR TREATMENT OR EMERGENCY MEDICAL SERVICES OR RESCUE EFFORTS in the event of an emergency or in the event of an injury or medical condition that develops or occurs during participation in the EVENTS or during the UNDERSIGNED's presence in or upon the premises, facilities, and locations where the EVENTS are or will be taking place. UNDERSIGNED expressly WAIVES AND RELEASES AND AGREES TO HOLD RELEASEES HARMLESS from and against any and all LIABILITY arising therefrom. - 4. EXPRESS ASSUMPTION RISK : Hereby acknowledges the ACTIVITIES can be EXTREMELY DANGEROUS and involve the RISK OF SERIOUS INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE. This agreement also constitutes an express and contractual ASSUMPTION OF ALL RISKS AND DANGERS associated with the EVENTS, which include,but not limited to,the risk of being struck by objects or equipment and/or making contact with or colliding with other participants,spectators, other persons, and natural or man made objects. The EVENTS will include participants of all skill and experience levels (including both professional and amateur persons) and varying levels of equipment, and UNDERSIGNED expressly assumes the risks associated with mixed and varying skill levels and varying equipment, UNDERSIGNED also acknowledges that there may be undefined and presently unknown risks and dangers associated with the EVENTS, and that there may be risks and dangers that may result from the ordinary NEGLIGENCE of the RELEASEES. This includes the potential ordinary NEGLIGENCE in the selection, use, operation, design, or maintenance of any equipment, course, competition , facility or service related to the EVENTS, UNDERSIGNED hereby expressly assumes all such risks and dangers whether presently known or unknown. The UNDERSIGNED ,also expressly acknowledges that injures received may be compounded or increased by ordinary NEGLIGENT RESCUE OPERATIONS OR PROCEDURES of the RELEASEES or others. - 5. INDEMNITY AND HOLD HARMLESS : If despite this Agreement, a claim is made against the RELEASEES on my behalf or on behalf of my minor participating child, I hereby agrees to DEFEND,INDEMNIFY, AND SAVE AND HOLD HARMLESS the RELEASEES and each of them from any loss,liability,damage, or cost (including attorneys' fees and court cost) they may incur arising out of or related to the UNDERSIGNED's presences in or upon the RESTRICTED AREA where the events are or will be taking place, whether cause by ordinary NEGLIGENCE , of the RELEASEES or otherwise. UNDERSIGNED also hereby agrees to DEFEND, INDEMNIFY,AND SAVE AND HOLD HARMLESS the RELEASEES from any loss , liability, damage or cost (including attorney's fees and court costs) caused by or arising out of any action or failure to act by UNDERSIGNED during or in connection with UNDERSIGNED's participation in EVENTS, and/ or arising out or UNDERSIGNED's improper,tortuous, and/or criminal conduct. - 6. INFORMED CONSENT AND VOLUNTARY PARTICIPATION : Fully acknowledges and understand that participation in the EVENTS will involve physical and strenuous activity and dangerous and changing circumstances and conditions.I have taken it upon myself to be fully informed,and to inform my minor participating child, of the numerous inherent risks and potential dangers associated with the EVENTS, including the RISK OF BEING INVOLVED IN AN ACCIDENT, CRASH OR COLLISION, AND SUFFERING SEVERE PERSONAL INJURY OR DEATH. I acknowledge, and I have informed my minor participating child,that our PERSONAL SAFETY CANNOT BE GUARANTEED. I acknowledge that my and my minor child's participating in the EVENT is completely voluntary,and we believe that potential benefits of participation outweigh the risk and danger associated with the EVENTS,and that all questions have been satisfactorily answered. - 7. OTHER PARTICIPANT OBLIGATIONS: I acknowledges that it is my responsibility to do all of the following on behalf of myself and my minor child: (1) fully disclose the RELEASEES any health issues or medications that are relevant to participation in the EVENTS: (2) inform RELEASEES if there are any activities or aspects of the program about which the UNDERSIGNED does not feel comfortable: (3) cease participation and promptly report any physical discomfort, illness or complications: and (4) clear his or her participation with his or her personal physician.I also acknowledge that I bear full responsibility to become aware of and familiar with any and all event ,series,and facility rules,regulations,and instructions, and to follow such rules, regulation and instructions. - 8. I represent and warrant that I have the full, complete and unrestricted right,power and authority to enter into this agreement, to waive and release all matters stated therein,expressly assume all risks and dangers associated with the EVENT(S) and to agree to indemnify the RELEASEES as stated herein. I sign this agreement on my own behalf and on behalf of my minor child. By my signature below, I warrant that I am the parent or legal guardian of the child, and that I am legally authorized to sign this agreement on behalf of the child.This agreement shall be binding as to my minor child,whether signed by one parent or both parents. - 9. Hereby agrees that this Agreement extends to ALL ACTS OF ORDINARY NEGLIGENCE by the RELEASEEES, including premises liability and NEGLIGENT RESCUE OPERATIONS,and it is intended to be as broad and inclusive as is permitted by law. UNDERSIGNED acknowledges that THIS AGREEMENT IS INTENDED TO BE FULLY SEVERABLE, and that if ant portion of this agreement is held invalid, it is agreed that the balance the agreement shall continue in full legal force and effect. That shall include modifying the agreement to allow the remainder of claim to be waived,released,and indemnified against in the event that the inclusion of any particular type of claim is found to be invalid or contrary to public policy. This Agreement is to be interpreted and enforced under Illinois law. - 10. Hereby accepts all terms set forth herein and acknowledges this is the complete agreement between the parties regarding these issues, and UNDERSTAND agrees and acknowledges that NO ORAL REPRESENTATIONS,STATEMENTS OR INDUCEMENTS HAVE BEEN MADE APART FROM THIS AGREEMENT. RELEASING PARTY HAS COMPLETELY READ BOTH PAGES OF THIS IMPORTANT LEGAL DOCUMENT AFFECTING SUBSTANTIAL LEGAL RIGHTS OF BOTH MYSELF AND MY MINOR CHILD. UNDERSIGNED SIGNS THIS DOCUMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO HIM OR HER AND UNDERSIGNED INTENDS HIS OR HER SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. UNDERSIGNED was given ample opportunity to read the agreement and/or have it reviewed by legal counsel of his or her choice. UNDERSIGNED was also offered a copy of this Agreement.
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Each adult applicant and the parent(s)/legal guardian(s) for each minor applicant must sign below and agree to all of the forgoing
Handler Electronic Signature
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Spouse Electronic Signature
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Relationship to driver(s)
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Relationship to driver(s)
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Please click on Paypal PAYMENT ONLY. do not use pay by credit card. Pay pal will allow you to pay by credit card.
Total
$0.00
