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This entire page must be returned with entry fee Agreement, Waiver, and Release In consideration of being permitted by the Capital City MOPARS and the Cordova Recreation and Park District to participate in the Car Show, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have or which may hereafter accrue as a result of my participation in said activity. This release is intended to discharge in advance the above club and district, other participants, coaches, instructors, officials, sponsors, advertisers, owners and lessees of the premises used to conduct the event and each of them, their officers, directors, agents, all of which are referred to as "Releasees", from all liability to the undersigned, my/our personal representatives, assigns, heirs and next of kin for any and all claims, demands, losses or damages on account of any injury, 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. I fully understand and acknowledge that: (a) There are risks and dangers associated with participation in Car Shows, including but not limited to those of bodily injury, partial and/or total disability, paralysis and death; (b) The social and economic losses and/or damages, which could result from those risks and dangers could be severe; (c ) these risks and dangers may be caused by the negligence of participants or the negligence of others, including but not limited to the "Releasees" named above; (d) There may be other risks not known to us or not reasonably foreseeable at the time. I further accept and assume such risks and responsibility for the losses and/or damages following such injury, Disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of "Releasees" named above.As parent(s) and/or legal guardian(s), I consent to instruct minor participating in Car Show to inspect the facilities and equipment to be used, or I will inspect said facility and equipment myself, and if he or she believes anything is unsafe, the participant or parent or legal guardian should immediately advise the Show representative of such condition and refuse to participate until faulty condition is corrected. Participant shall be fully instructed by parent(s) and/or legal guardian(s) and encouraged to adhere to any Show rules established by sponsors and common courtesy. PARENTAL CONSENT: I hereby consent that my child ,_______________, participate in the above activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity. The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it, and sign it voluntarily. **SIGNATURE:_________________________________ **PRINT NAME:___________________________________ ** (Required of all applicants ) (Parent/Guardian, if participant under 18 years of age) DATE:__________________Please include a SELF ADDRESSED, STAMPED ENVELOPE for return confirmation ONLYPlease Print NAME - LAST_____________________________________FIRST_____________________________________ ADDRESS________________________________________CITY______________________________________ STATE______ ZIP CODE_____________ EMAIL_________________________________________________ PHONE NUMBER ____________________ CLUB / COMPANY NAME_______________________________ CAR 1 YEAR____________MAKE_________________MODEL__________________ENGINE CID_________ CAR 2 YEAR____________MAKE_________________MODEL__________________ENGINE CID_________ ENTER MY VEHICLE IN CLASS: (CAR 1)_______________________________________________________ ENTER MY VEHICLE IN CLASS: (CAR 2)_______________________________________________________ Pre-registered is $25.00 ($30 day of show) Amount $_____ Vendor space ($100.)Amount$_____ Swap space =10x20 ($30 for one / $50 for two) Amount $ ______ Car corral ($20 / car) Amount $ _____ HOW DID YOU HEAR ABOUT THIS SHOW?_____________________________________________________ MAKE CHECK OR MONEY ORDER PAYABLE TO: CAPITAL CITY MOPARS P.O. Box 340426 . Sacramento CA 95834 |