Fill and Sign the Injury Indemnity Form

Release, Waiver of Liability, Assumption of Risk, and Indemnity Agreement Regarding Race or Event Involving ATV, Motorcycle, Motocross, and/or 4x4 Off-Road Vehicles This Release, Waiver of Liability, Assumption of Risk and Indemnity Agreement ( A Release @ ) is given this the ____ day of ___________, 20___, from _________________________ (Name of Participant) in favor of and to _________________________ , of __________________________________________________ (street address, city, county, state, zip code) by _________________________ , who resides at __________________________________________________ (street address, city, county, state, zip code), hereinafter referred to as A Participant @ . Participant is: ( ) Over the age of eighteen (18) ( ) Under the age of eighteen (18) and, if under the age of eighteen (18) _________________________________ (Print name of Legal Guardian of Participant) is the Legal Guardian for the above. For and in consideration of being permitted to compete in __________________________________________________ (name of Event and brief description) , hereinafter called A Event, @ and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Participant _________________________________ ________________________ [if applicable add A and Guardian, hereinafter jointly and severally referred to as A Participant @ )], hereby releases, waives and discharges_________________________ , its ____________________________________ (e.g., officers and members, promoters, sponsors, advertisers, owners and lessees of the premises) hereinafter referred to as A Releasees, @ and each of them, from all liability to the Participant, his/her spouse, legal representatives, heirs and assigns, for any and all loss or damage, and any claim or damages resulting therefrom, on account of injury to Participant = s person or property, even injury resulting in death of Participant, whether caused by the negligence of Releasees while the Participant is ________________________________________ (e.g., competing, working or for any purpose participating) in Event. Participant agrees to indemnify the Releasees and hold them harmless from any loss, liability, damage or cost they may incur due to the participation of Participant in Event, whether caused by the negligence of the Releasees or otherwise. Participant hereby assumes full responsibility for the risk of bodily injury, death or property damage or otherwise while in or upon __________________________________________ __________________________________________________ (describe area in which activity will occur), and while competing, officiating in, working for or any other purpose regarding participating in Event. Participant hereby acknowledges that the activities of the Event are very dangerous and involve the risk of serious injury and or property damage . Participant also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releasees. Participant hereby agrees that this Release extends to all acts of negligence by the Releasees, including, but not limited to, negligent rescue operations and is intended to be as broad and inclusive as is permitted by the laws of the state of _____________, and that if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This Release constitutes the sole and only agreement of Participant and _________________________ , and supersedes any prior understandings or written or oral agreement respecting the subject matter of this Release. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and _________________________________ , and I have signed it of my own free will. Witness my signature, as of the day and date first above named. ______________________________ ________________________________ Participant Guardian (if applicable)