“MOTOCROSS
CLINIC”
REGISTRATION FORM
Fill
out this form completely in
your computer, print it
and SIGN the waiver and release form.
Date
for Clinic
City:
Track:
Name:
Age:
Address:
Ste./Apt.
City:
State:
Zip Code:
E-Mail:
Telephone:
Emergency Telephone:
DATE:
-
WAIVER AND RELEASE OF LIABILITY-
In
consideration of the acceptance of my registration request and/or participation
in the above Motocross Clinic(s) operated and/or under the management of Too
Much Fun Promotions, the sponsors, Teachers and/or contract entities, I hereby
release all liability from said parties and I assume all liability for any and
all claims and actions of any kind for personal injuries and/or property damage
which i may cause or sustain during the Clinic or during my travel to and from
the Clinic, and I agree to pay any and all costs including attorney's fees that
may be incurred by the above entities as a result of any such claim. I attest
and verify that I am in good health and that I am adequately trained to
participate in this type of Clinic and my physical condition have been verified
by a medical doctor. I hereby acknowledge that I have sole responsibility for my
personal possessions and athletic equipment during the Clinic or its related
activities, I hereby grant to any and all of the foregoing to use any
photograph, videotape, motion picture or any other record of this Clinic for any
purposes whatsoever including broadcasts, telecasts and the press as they
pertain to the Clinic. I hereby consent to receive medical treatment which may
be deemed advisable during this Clinic and understand that I am solely
responsible for all cost relation to medical transportation and/or evacuation. I
hereby agree that if the Clinic is canceled due to storm, rain, inclement seas
or weather, wind or other "act of god" conditions, my entry fee shall
be nonrefundable. I understand that all entry & t-shirt are nonrefundable-.
I also understand that my entry is nontransferable. I also agree that any legal
claim, can only take action in the State of Baja California, Mexico.
I FURTHER FULLY UNDERSTAND THAT THERE IS NO RIDER INSURANCE PROVIDED FOR THIS
CLINIC, RIDERS MUST CARRY THEIR OWN ACCIDENT INSURANCE.
I
have read and fully understand and agree to this release, waiver and
indemnification form.
Signature:_________________________
Date:_____________
Parent
or legal guardian's signature if under 18 years of age authorizes emergency
medical treatment.
Name
of Rider's Insurance Company:______________________________________