RELEASE OF LIABILITY

HEAT#____________

The undersigned desires and intends to participate in the Demolition Derby and related activities during the Kirwin Old Settler’s Day which is of a hazardous nature.  For the privilege of participation in these activities, I hereby release from liability and promise to indemnify the promoters, announcer, employee, and agents and the judges and flagmen from any claim for injury or damage to myself and other persons or any property arising out of my participation in the Demolition Derby or any other related activity.  I also agree to use the track in its present condition and accept all judges’ decisions as final.

NAME:___________________________________________AGE:___________

ADDRESS:________________________________________________________

City                         State           Zip

I, THE DRIVER, HAVE READ THE RULES AND ACCEPT THE DECISION OF THE JUDGES AS FINAL.  I AGREE TO USE THE TRACK IN ITS PRESENT CONDITION.  

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SIGNATURE                                                                                        DATE

IF UNDER 18, SIGNATURE OF PARENT OR GUARDIAN IS REQUIRED

NUMBER ON CAR____________________

MAKE AND YEAR OF CAR__________________________________________