Membership and Facility Rules

Size: px
Start display at page:

Download "Membership and Facility Rules"

Transcription

1 Membership and Facility Rules 1. Membership is for the period of thru , which includes: Access to the tracks when the tracks are open o In the event you would want to ride on a day the track is/would be closed, prior arrangements must be made with MOTOvation staff ahead of time. o If you choose to participate in a training class, track fees will be waived for all members 2. All riders are required to sign a waiver of liability form before riding. 3. Riders under 18 must be accompanied by a parent or an approved guardian with a signed, notarized, guardian release form. 4. Riders are required to wear the following equipment: helmet, above the ankle boots, long sleeve jersey, riding pants, gloves and protective eye wear 5. Ride in 1 st gear only while in the pit areas. 6. Riders will observe and obey all safety and caution signs/flags. 7. No riding in unauthorized areas. 8. Entry/Exit track only in designated areas. 9. NO pit bike riding in the pits, except if You are handicapped or in need of assistance Permission obtained from MOTOvation MX staff member You are identified as a MOTOvation MX, Event Staff member 10. Pee-Wee track is for Pee-Wee and 65cc bikes only no pit bikes or big bikes are allowed on this track 11. Spectators are not allowed on the in-field of the track, unless permission is obtained by staff. 12. All buildings at the facility are Private Property, please do not enter with prior consent from a MOTOvation MX, Event Staff member 13. Please pick up after yourself and dispose of all trash in designated areas. 14. Pets must be on a leash at all times.

2 2018 Membership Information Member: Emergency Contact Information Contact Name: Relationship: Additional Family Member(s): 1. Name: Age: 2. Name: Age: 3. Name: Age: 4. Name: Age 5. Name: Age Note: All members will receive a Membership card. When signing in, you will need to show proof of membership prior to riding.

3 2018 Membership I have read (Member and Facility Rules), understand and agree to abide by the terms of this membership: Member: Print Name: Signature: Signature of additional Family Member(s): Signature of authorized MOTOvation MX Training Facility representative: Internal Use Only: Membership # Package: Initials: Notes / Comment:

4 2018 Minor - Waiver of Liability MUST be Notarized and on File for 2018 Season Minor Information: Please Print Clearly Fathers Name: Mothers Name: I recognize and acknowledge that there are certain risks of physical injury to participants in this activity, and I voluntarily agree to assume the full risk of any injuries (crippling injury or death), damages or loss, regardless of severity, that my minor child may sustain while participating in any/all activities at MOTOvation MX Training Facility, Inc. I further agree to waive and relinquish all claims my minor child may have while participating in all activities against MOTOvation MX Training Facility, Inc. including its sponsors, volunteers and employees. My parents and/or legal guardian and have I discussed the risk of danger and the possibility of being injured in which I fully understand. I will release and forever discharge MOTOvation MX Training Facility, Inc. from any and all claims to myself and/or property for injuries, damages or loss that my minor child may accrue while upon the premises, and relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all cost to those persons or organizations connected with any event for damages incurred as a result of my negligence. I HAVE FULLY READ OR HAVE BEEN READ THE ABOVE ASSUMPTION OF RISK. I FULLY UNDERSTAND WHAT IT MEANS, AND HAVE SIGNED IT VOLUNTARILY. Signature of Minor: Signature - Father: Signature Mother Notary Information: Signed before me on this day of 20 (Notary Seal) Notary Signature: My Commission Expires:

5 Waiver of Liability MUST be on file for 2018 Season Note: All members of the membership agreement need to complete a Waiver of Liability form. Member: Please Print Clearly Emergency Contact Information Contact Name: Relationship: I recognize and acknowledge that there are certain risks of physical injury to participants in this activity, and I voluntarily agree to assume the full risk of any injuries (crippling injury or death), damages or loss, regardless of severity, that my minor child and/or I may sustain while participating in any/all activities at MOTOvation MX Training Facility, Inc. I further agree to waive and relinquish all claims I, and/or my minor child may have while participating in all activities against MOTOvation MX Training Facility, Inc. including its sponsors, volunteers and employees. I do hereby fully understand the risk of danger and will release and forever discharge MOTOvation MX Training Facility, Inc. from any and all claims to myself and/or property for injuries, damages or loss that my minor child and/or I may accrue to me and/or my minor child while upon the premises, and relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all cost to those persons or organizations connected with any event for damages incurred as a result of my negligence. Signature of Rider: Witness

Badlands Motocross Park

Badlands Motocross Park Badlands Motocross Park 5423 County Road 1095, Celeste, Texas 75423 Badland s Main line: (972) 742-2228 Website: www.badlandsmx.com Dear Members, Badlands is now offering Practice Memberships! Full Year:

More information

Ogden Cycle Association Membership Agreement

Ogden Cycle Association Membership Agreement Date: Ogden Cycle Association Membership Agreement Membership Type: (mark all that apply) Single Family Non-Wor king Charter Life Cash / Check # Amount Paid $ Receipt # New Member / Annual Renewal I agree

More information

MEMBERSHIP INFORMATION FORM

MEMBERSHIP INFORMATION FORM MEMBERSHIP INFORMATION FORM ADULT MINOR Applicant herby applies for an Membership at Freedom MX. Upon becoming a Member of Freedom MX, Applicant agrees to be bound by the rules and regulations set forth

More information

Westhollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability

Westhollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability Westhollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability In consideration of my use of Westhollow Village s swimming pools, I hereby forever

More information

2014 ANNUAL COVENANT NOT TO SUE, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

2014 ANNUAL COVENANT NOT TO SUE, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT 2014 ANNUAL COVENANT NOT TO SUE, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT LAST NAME DRIVERS LICENSE # EMERGENCY CONTACT: FIRST NAME STATE OF ISSUE RELATIONSHIP: EMERGENCY CONTACT

More information

PRINTING INSTRUCTIONS

PRINTING INSTRUCTIONS PRINTING INSTRUCTIONS All forms must be printed in COLOR on standard 8.5 x 11 paper. Black and white or illegible copies will NOT be accepted. 1. The MINOR VEST APPLICATION is a one (1) page form. 2. The

More information

White Rock Ranch All Breeds Schooling Show 295 Webb Road Watsonville, CA

White Rock Ranch All Breeds Schooling Show 295 Webb Road Watsonville, CA White Rock Ranch All Breeds Schooling Show Start time 8:30 AM Please remember, No Dogs on Show Grounds White Rock Ranch All Breeds Schooling Show Horse Show Rules 1. The safety of both the rider and the

More information

CITY KIDS DAY CAMP REGISTRATION FORM

CITY KIDS DAY CAMP REGISTRATION FORM RETURN CAMP ENTRY FORM WITH PAYMENT TO: M.C. PARKS 100 E. MICHIGAN BLVD. SUITE 2 MICHIGAN CITY, IN 46360 (219) 873-1506 www.michigancityparks.com CITY KIDS DAY CAMP REGISTRATION FORM 1. HOUSEHOLD INFORMATION

More information

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone: Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player

More information

*** ALL handlers/riders/drivers MUST complete this form *** CONDITIONS OF ENTRY AHSA LIABILITY DECLARATION EVERY HANDLER, RIDER, DRIVER, GROOM & ANYONE HANDLING A HORSE OR PONY MUST COMPLETE THE ARABIAN

More information

Burbank Sister City Committee Burbank Public Library 110 N Glenoaks Blvd. Burbank CA 91502

Burbank Sister City Committee Burbank Public Library 110 N Glenoaks Blvd. Burbank CA 91502 January 7, 2016 Burbank Sister City Committee Burbank Public Library 110 N Glenoaks Blvd. Burbank CA 91502 Dear Bike-a-Thon Rider: We look forward to your participation in the Fourth Annual Bike-a-Thon

More information

READ THOROUGHLY AND CAREFULLY. YOU, YOUR FAMILY AND GUESTS PARTICIPATE AT YOUR OWN RISK.

READ THOROUGHLY AND CAREFULLY. YOU, YOUR FAMILY AND GUESTS PARTICIPATE AT YOUR OWN RISK. NORTH PACOLET ASSOCIATION, INC. (NPA) SLATER PROPERTIES, INC. (SPI), LANDOWNERS OF THE NPA AND ADJACENT AND ABUTTING PROPERTY OWNERS (THAT ALLOW SAID USES OF THEIR PROPERTY) RELEASE, WAIVER AND INDEMNIFICATION

More information

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree: WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially

More information

Event Registration Form

Event Registration Form Event Registration Form Event and Date: Rider s Name: Rider s Address: Rider s Cell Phone: Rider s Age: Horse s Name: What level is your horse currently training: If you will be riding in the Fix-A-Test

More information

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team

More information

SHORT-TERM MISSIONS APPLICATION

SHORT-TERM MISSIONS APPLICATION GENERAL INFORMATION Date Last Name First Name Middle Name Please print your name clearly EXACTLY AS IT APPEARS ON YOUR PASSPORT Present address: City State Zip DOB / / Age Gender: M F Grade Email Home

More information

Raising Money for Autism

Raising Money for Autism Raising Money for Autism Appendix I 1.) Release of Liability Form: 2.) Consent and Release of Guardian Form: 3.) Volunteer Sign Up Sheet 4.) Bowl-a-Thon Flyer In this section you will find all the forms

More information

(If you are a messenger, your pastor must sign the messenger form, if there is no Pastor s signature, you cannot vote at the business meeting.

(If you are a messenger, your pastor must sign the messenger form, if there is no Pastor s signature, you cannot vote at the business meeting. Southern Baptist Conference of the Deaf At Ridgecrest Conference Center, NC Registration Form July 15-19, 2019 Important: one form for each person (even if same family) Full Name: Age: Gender: M or F Marital

More information

Please fill out both sides of this form!!!

Please fill out both sides of this form!!! $ # Circle one: Mixed Doubles Rockbridge Hunt Hunter Pace & Trail Ride Please fill out both sides of this form!!! Entry fee: Adult rider (18 and over) -- $35 per horse Junior rider (under 18) -- $20 per

More information

Can-Am X-Team Racer Support Program Application Form PLEASE PRINT CLEARLY. INCOMPLETE OR ILLEGIBLE FORMS WILL DELAY PROCESSING.

Can-Am X-Team Racer Support Program Application Form PLEASE PRINT CLEARLY. INCOMPLETE OR ILLEGIBLE FORMS WILL DELAY PROCESSING. Supporting Dealer Identification BRP Dealer # : Dealership Name : Dealership Fax Number : Dealer Contact : Email : Phone number : Racer Identification You must have had some racing experience in the past

More information

To: 2011 Pro Motocross Credential Applicants

To: 2011 Pro Motocross Credential Applicants To: 2011 Pro Motocross Credential Applicants Welcome to AMA Pro Motocross Championship racing. Attached is the 2011 Season Credential Application packet for the Lucas Oil AMA Pro Motocross Championship,

More information

Castle Mountain Ski/ Snowboard Trip Skiing/ Snowboarding at Castle Mountain Resorts (CMR) 6:55 am 4:30pm on Monday, January 22, 2017

Castle Mountain Ski/ Snowboard Trip Skiing/ Snowboarding at Castle Mountain Resorts (CMR) 6:55 am 4:30pm on Monday, January 22, 2017 Castle Mountain Ski/ Snowboard Trip Skiing/ Snowboarding at Castle Mountain Resorts (CMR) 6:55 am 4:30pm on Monday, January 22, 2017 Dear Parents/ Guardians, The aim of Physical Activity Programs in Alberta

More information

2017 Minor Crew Check-List

2017 Minor Crew Check-List 2017 Minor Crew Check-List Following you will find the necessary forms to complete your 2017 IMSA Membership/License application and Annual hard card application. This checklist is meant to assist you

More information

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY PUEBLO RANGERS Individual Waiver Soccer Club PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY (MUST BE COMPLETED AND PRESENTED AT LEAST 30 MINUTES PRIOR TO YOUR FIRST

More information

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m. PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release

More information

Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers)

Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) (Commercial Activity Providers) WAIVER AND RELEASE OF LIABILITY

More information

Blue Knob Snow Sports Club, Inc Registration Form 2018/2019 Ski Season

Blue Knob Snow Sports Club, Inc Registration Form 2018/2019 Ski Season Registration Information: 1. All participants should be at least 8 years of age (Category U10) by Dec 31 st 2018. 2. Intermediate skiing skills are necessary (parallel turns on most slopes). 3. Participants

More information

Instructions for Completing Ford DSFL Waivers

Instructions for Completing Ford DSFL Waivers Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly

More information

THE OPERATOR OF THE HOUSE OF VANS IS SPARROW HOUSE LIMITED CO NUMBER REGISTERED ADDRESS 111 HIGH STREET, BILLERICAY, ESSEX.

THE OPERATOR OF THE HOUSE OF VANS IS SPARROW HOUSE LIMITED CO NUMBER REGISTERED ADDRESS 111 HIGH STREET, BILLERICAY, ESSEX. ALL SKATEPARK USERS MUST READ AND UNDERSTAND THIS DOCUMENT AND CONSIDER IT CAREFULLY BEFORE SIGNING.THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS AND MAY RESTRICT OR PREVENT YOU BRINGING A LEGAL ACTION AGAINST

More information

2016 OUCI Chinese Bridge Summer Camp Application

2016 OUCI Chinese Bridge Summer Camp Application STUDENT INFORMATION Name (as it appears on your passport) Passport # Passport Expiration Date DOB Gender Cell Phone Email Address City State Zip PARENT/GUARDIAN INFORMATION Parent Phone Email Parent Phone

More information

ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION

ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION Player Information First Name: Last Name: Address: City, State, Zip: Home Phone: Email: Date Of Birth: School: Grade: Jersey Size: Age Division Select

More information

EXHIBIT C RELEASE, INDEMNIFICATION, AND HOLD HARMLESS AGREEMENT

EXHIBIT C RELEASE, INDEMNIFICATION, AND HOLD HARMLESS AGREEMENT EXHIBIT C RELEASE, INDEMNIFICATION, AND HOLD HARMLESS AGREEMENT Attendee Name: Parent/Guardian Name: Effective Date:, 20 Camp Session Dates: Coach: Company: Full Name Full Legal Name If no company, please

More information

Summer Horse Camps 2019 Things to Remember. Camp Location: Please drive slowly on Rocky Road. on the first day

Summer Horse Camps 2019 Things to Remember. Camp Location: Please drive slowly on Rocky Road. on the first day Summer Horse Camps 2019 Thank you for making Cedar Ridge Equine Horse Camp a part of your summer vacation! We look forward to having you. This year each group will enjoy a number of daily activities including

More information

Summer Sailing Registration

Summer Sailing Registration Summer Sailing Registration Date Sailor s Name Birthday Address City State Zip Mothers Name Home # Cell/Work # Fathers Name Home # Cell/Work # Emergency Contact Name Phone # (This person will be in a notebook

More information

Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child

Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child Registration Form Please fill out and return to the address below

More information

Release and Waiver of Liability. Release and Waiver of Liability for Adults Page 2 & 3. Release and Waiver of Liability for Minor Page 4 & 5

Release and Waiver of Liability. Release and Waiver of Liability for Adults Page 2 & 3. Release and Waiver of Liability for Minor Page 4 & 5 Release and Waiver of Liability Release and Waiver of Liability for Adults Page 2 & 3 Release and Waiver of Liability for Minor Page 4 & 5 1 Release and Waiver of Liability for Adults Adult - An adult

More information

PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS!

PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS! 109 Harrison St. NE, Leesburg, VA 20176 Phone: 703.737.6772 Fax: 703.737.6788 www.loudounhabitat.org RELEASE AND WAIVER OF LIABILITY FOR MINORS PLEASE READ CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS

More information

RYLA 2018 Camper Application Rotary District 5520

RYLA 2018 Camper Application Rotary District 5520 RYLA 2018 Camper Application Rotary District 5520 RYLA Boys Camp - Sunday, July 15th - Saturday, July 2 1st RYLA Girls Camp - Saturday, July 21st- Friday, July 27th Applicant must have completed their

More information

VENTURA COUNTY FAIR EXCA COWBOY CLASSIC

VENTURA COUNTY FAIR EXCA COWBOY CLASSIC VENTURA COUNTY FAIR EXCA COWBOY CLASSIC Presents Event Date: August 10, 2017 Triple Point Race (1 Run) Multiple Division Entries Permitted Rider Name: EXCA Member #: Address: City / State / Zip: Telephone:

More information

EAGLE COUNTY ADOPT-A-TRAIL PROGRAM GUIDELINES

EAGLE COUNTY ADOPT-A-TRAIL PROGRAM GUIDELINES EAGLE COUNTY ADOPT-A-TRAIL PROGRAM GUIDELINES Eagle County has recently initiated an Adopt-A-Trail program. The program allows any organization to take pride in their community by keeping it litter free.

More information

SVFD 3 on 3 Road Hockey Challenge

SVFD 3 on 3 Road Hockey Challenge Water Street, Shelburne Registration starts at 10am Games start at 10:30am Registration Process 1. Complete the Team Registration form 2. Each player completes the Adult Registration Form or the Youth

More information

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR

CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start

More information

2019 OWNER / DRIVER / CREW APPLICATIONS

2019 OWNER / DRIVER / CREW APPLICATIONS Application Summary: 2019 Owner License: The fee for a 2019 Modified Racing Series Owners license is $250.00 (two-hundred fifty dollars). An Owner s License gives the owner rights to a car number until

More information

BubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY

BubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY BubbaFest Florida Keys November 3th November 10th, 2018 Please TYPE or PRINT CLEARLY Name: Male: Female Address: Age City, State & Zip: Home Number: Email Address: Cell Phone: Shirt Size Vegetarian meal

More information

Adopt-A-Road Program. For more information, please contact:

Adopt-A-Road Program. For more information, please contact: ADOPT-A-ROAD is a volunteer litter control program sponsored by the City of Apopka. Adopt-A- Road allows citizens to enhance the level of community pride in their surrounding area by reducing litter. Participants

More information

APPLICATION FOR THE ADOPT-A-STREET PROGRAM

APPLICATION FOR THE ADOPT-A-STREET PROGRAM APPLICATION FOR THE ADOPT-A-STREET PROGRAM Group Name (Applicant): Contact Person: E-Mail Address: Address: Phone Number: Street Name and Limits: I,, acting as or for the above named Applicant, acknowledge

More information

Lifestyle Action Sports Park Legal Contract

Lifestyle Action Sports Park Legal Contract Lifestyle Action Sports Park Legal Contract Welcome to an LAS facility. Riding dirt bikes, golf carts, pit vehicles, bicycles, ATV s, watercrafts, water activities including, but not limited to; fishing,

More information

2010 POLARIS ATV CONTINGENCY PROGRAM

2010 POLARIS ATV CONTINGENCY PROGRAM 2010 POLARIS ATV CONTINGENCY PROGRAM Welcome to the Polaris ATV Contingency Program. For 2010 Polaris is offering an industry leading contingency program for the top seven recognized racing series in North

More information

Honey Bee Pageant Application

Honey Bee Pageant Application Honey Bee Pageant Application Applications need to be returned to North Logan City Office, 2076 N 1200 E, or emailed to northloganrec@gmail.com, by March 27, 2017 by 5 pm. (No late applications will be

More information

General Policy - Off-Campus Travel of Student Groups

General Policy - Off-Campus Travel of Student Groups General Policy - Off-Campus Travel of Student Groups Policy: All off-campus travel to an activity or event involving students shall be conducted in accordance with the State Board of Higher Education (SBHE)

More information

OPEN DRESSAGE JACKPOT

OPEN DRESSAGE JACKPOT OPEN DRESSAGE JACKPOT SATURDAY 16 th APRIL, 2016 PONY CLUB VICTORIA EQUESTRIAN CENTRE 640 Yarra Junction Noojee Rd, Gladysdale Vic 3797 *Open to all RIDERS Entries CLOSE: 6 th April, 2016 Proudly Sponsored

More information

Paul Hastings LLP Defined Contribution Retirement Plan (401k) Beneficiary Designation Form

Paul Hastings LLP Defined Contribution Retirement Plan (401k) Beneficiary Designation Form Paul Hastings LLP Defined Contribution Retirement Plan (401k) Beneficiary Designation Form Print Name: Job Title: Social Security Number: (Optional) I understand that benefits are paid out in a lump sum.

More information

InnoWorks 2017 Student Application Information and Instructions

InnoWorks 2017 Student Application Information and Instructions InnoWorks 2017 Student Application Information and Instructions Welcome to the 2017 InnoWorks Workshop Student Application! Since 2003, InnoWorks has successfully conducted 50+ summer workshops, serving

More information

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of

More information

Adopt-a-Flowerbed Agreement

Adopt-a-Flowerbed Agreement Adopt-a-Flowerbed Agreement Denver Parks and Recreation Adopt-A-Flowerbed Agreement Date of Request: Location: ORGANIZATION: GROUP CONTACT PERSON: PHONE: GROUP CONTACT PERSON: PHONE: GROUP CONTACT PERSON:

More information

Miss North Logan City Pageant Application

Miss North Logan City Pageant Application Miss North Logan City Pageant Application You re invited to apply for the Miss North Logan City Pageant! Applications need to be returned to North Logan City Office, 2076 N 1200 E, or emailed to northloganrec@gmail.com,

More information

ALL DRIVERS MUST COMPLETE INFORMATION BELOW

ALL DRIVERS MUST COMPLETE INFORMATION BELOW Mailing Address: PO Box 322 Lancaster, NY 14086 Phone: 716-759-6818 Website: LancasterNationalSpeedway.com 2018 STOCK CAR REGISTRATION, MEMBERSHIP & NUMBER APPLICATION PLEASE PRINT LEGIBLY ALL DRIVERS

More information

Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement

Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement Name: Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement I, the undersigned individual, desire to use the U ROCK ( U ROCK s.a.l.) facilities located at Rebound

More information

Evaluation and Team Registration Information

Evaluation and Team Registration Information Tryout Date: May 26, 2018 Evaluation and Team Registration Information Time: (3-5 years) 9:00 to 10:00 Time: (6-10 years) 10:00 to 12:00 Time: (11-13 years) 1:00 to 3:00 Time: (14-18 years) 3:00 to 5:00

More information

THE URBAN SLIDE EVENT GUIDE

THE URBAN SLIDE EVENT GUIDE THE URBAN SLIDE EVENT GUIDE Welcome to The Urban Slide! Thanks to you and your sliding buddies, the Worlds Largest Slip n Slide is finally here!! You have made it possible for us to take this one of a

More information

CAMELOT FARMS LLC BOARDING AGREEMENT NAME OF OWNER/BOARDER ADDRESS STATE ZIP WORK# ( ) OTHER# ( ) EMERGENCY CONTACT NAME NAME OF HORSE

CAMELOT FARMS LLC BOARDING AGREEMENT NAME OF OWNER/BOARDER ADDRESS STATE ZIP WORK# ( ) OTHER# ( )  EMERGENCY CONTACT NAME NAME OF HORSE CAMELOT FARMS LLC BOARDING AGREEMENT DATE NAME OF OWNER/BOARDER ADDRESS STATE ZIP CELL# ( ) HOME# ( ) WORK# ( ) OTHER# ( ) EMAIL TRAILER LICENSE PLATE # EMERGENCY CONTACT NAME EMERGENCY CONTACT # ( ) NAME

More information

Grand Island Central Catholic Shooting Team

Grand Island Central Catholic Shooting Team Letter Program Requirements Signed Parental Consent Form. Signed Code of Conduct Form (Student & Parent / Guardian). Be enrolled At GICC during the time of participation. Follow & Live The "Code of Conduct".

More information

Form Generic Liability Waiver. Legal Disclaimer

Form Generic Liability Waiver. Legal Disclaimer Form Generic Liability Waiver Developed by Ashley Newhall * and Kathleen Tabor Legal Disclaimer Attached is a generic liability waiver. This waiver is for educational purposes only! Using this form does

More information

Season Signing Package

Season Signing Package SIGNING NIGHT DETAILS MANDATORY MEETING: MONDAY, NOVEMBER 12, 2018 ALL MEETINGS WILL TAKE PLACE AT THE XCELERATION SPORTS FACILITY, 360 FERRY STREET, MARTINEZ MEETING TIMES ARE AS FOLLOWS: 6:00PM 7:00PM

More information

PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

PARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE

More information

MEMBERSHIP APPLICATION; CONSENT and MEDICAL CERTIFICATION PROGRAM: AFTER-SCHOOL, SUMMER, FOOTBALL, SOCCER, BASKETBALL, MARTIAL ARTS, ETC.

MEMBERSHIP APPLICATION; CONSENT and MEDICAL CERTIFICATION PROGRAM: AFTER-SCHOOL, SUMMER, FOOTBALL, SOCCER, BASKETBALL, MARTIAL ARTS, ETC. MEMBERSHIP APPLICATION; CONSENT and MEDICAL CERTIFICATION PROGRAM: AFTER-SCHOOL, SUMMER, FOOTBALL, SOCCER, BASKETBALL, MARTIAL ARTS, ETC. MEMBER INFORMAITON Member Name: LAST FIRST MIDDLE Address: City

More information

Brentsville Stables, LLC Release of Liability

Brentsville Stables, LLC Release of Liability Brentsville Stables, LLC Release of Liability 1. I, (Participant, Parent or Guardian s Name) acknowledge that I have voluntarily applied to participate in horseback riding and training (which shall also

More information

TEXAS STATE UNIVERSITY SYSTEM

TEXAS STATE UNIVERSITY SYSTEM TEXAS STATE UNIVERSITY SYSTEM CHRISTMAS MOUNTAINS 1-DAY PERMIT APPLICATION General Information Number of People in the Group: :, 20 Method of Travel: Foot Mountain Bike Horseback 4-Wheel Drive ATV # of

More information

Please note that all forms require ORIGINAL signatures. Send your completed forms and check made out to Seneca Valley Pony Club to:

Please note that all forms require ORIGINAL signatures. Send your completed forms and check made out to Seneca Valley Pony Club to: This is the 2019 membership package for Seneca Valley Pony Club. Membership in Pony Club requires two steps. First, a member must be a member of United States Pony Club. For new members, a form for USPC

More information

Information about membership -

Information about membership - MEMBERSHIP INFORMATION 2018 We are excited about ST. CROIX JOAD and the opportunities that will present themselves to youth archers ages 8-20. ST. CROIX JOAD is one of only a handful USA ARCHERY JOAD clubs

More information

Loch Nyora Pony Club

Loch Nyora Pony Club Loch Nyora Pony Club Inc A0005690A And Open Show Jumping Competition 6 th January 2019 To be held at the Loch Nyora Pony Club Grounds 27-41 Yannathan Rd / McDonalds Track Nyora 3987 Enquires:- Chris Hill

More information

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / / Physical Examination Information Date / / Name of Camp: Name of Participant: Age: Birth date: / / Each participant must EITHER attach a copy of a physician conducted sports examination applicable to this

More information

SCCA Rally/Solo Release and Waiver Guidelines

SCCA Rally/Solo Release and Waiver Guidelines RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA

More information

Street Address: State: Zip: Phone: Registration Form

Street Address: State: Zip: Phone:   Registration Form 2018 Annual Lampasas Spring Ho Festival Kayak Races Race Day Saturday July 14, 2018 See Division Categories for Start times Early Registration thru July 12th, $10 Registration on Day of Race, $15 Paddler

More information

SKATEBOARD COMPETITION ENTRY FORM

SKATEBOARD COMPETITION ENTRY FORM CITY OF KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES SKATEBOARD COMPETITION ENTRY FORM For your convenience, competition entry forms will be accepted in person, by mail, via fax or email at the location

More information

BUTLER BOYS SCHOLASTIC LACROSSE ASSOCIATION PLEASE SIGN ALL FORMS & RETURN ENTIRE PACKET

BUTLER BOYS SCHOLASTIC LACROSSE ASSOCIATION PLEASE SIGN ALL FORMS & RETURN ENTIRE PACKET REGISTRATION FORM PACKET 2015 BUTLER BOYS SCHOLASTIC LACROSSE ASSOCIATION PLEASE SIGN ALL FORMS & RETURN ENTIRE PACKET BUTLER BOYS SCHOLASTIC LACROSSE ASSOCIATION RELEASE FORM In consideration of the acceptance

More information

Membership Registration Form

Membership Registration Form Today s Date: Leeward Judo Club Membership Registration Form Primary Dojo Location (Check box): Pearl City Waipahu Student Information: Name (First, MI, Last) Date of Birth Age Sex Male Female Address

More information

PERSONAL INFORMATION CAR INFORMATION. Car Number: Car Owner:

PERSONAL INFORMATION CAR INFORMATION. Car Number: Car Owner: 2019 Sprint Car Bandits (SCB) COMPETITOR APPLICATION This form must be completed before any driver pay will be issued. Please print clearly. All fields on application must be completed. Completion of form

More information

All applications to sell at the market will be reviewed by the owners of the market. If the

All applications to sell at the market will be reviewed by the owners of the market. If the Wolf Ranch Farmers Market 1015 W University Avenue Georgetown, TX 78628 Market Hours: Every Saturday from 8:30am to 1pm Owners: John & Yen Selking - Two Happy Children Farm Stormy Stouder - StouderHouse

More information

REGISTRATION FORM. 483 Quatsino Boulevard Friday, July 26, 2019 at 6:00 pm

REGISTRATION FORM. 483 Quatsino Boulevard Friday, July 26, 2019 at 6:00 pm 2019 REGISTRATION FORM 483 Quatsino Boulevard Friday, July 26, 2019 at 6:00 pm Full Name: Family or Team Name: Parent/Guardian Contact Name: Individual Parent/Guardian Phone #: OR Family Assigned Race

More information

2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS

2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS 2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions

More information

2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS

2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions

More information

ONTARIO ELITE CIRCUIT #4

ONTARIO ELITE CIRCUIT #4 ONTARIO ELITE CIRCUIT #4 Hosted by: Newmarket Jets Speed Skating Club Newmarket ON January 26-27, 2019 REGISTRATION FORM Name #1 (new racers only) (111m track) Name #2 (new racers only) (111m track) Name

More information

ATV Drag Racing Rules and Safety Regulations

ATV Drag Racing Rules and Safety Regulations ATV Drag Racing Rules and Safety Regulations Monday, August 13, 2018 7:30pm Arrival at the Dalamar Street gate only and Entry Procedures begin at 3:00 PM and end at 6:00 PM. Entry after this time will

More information

Parental Consent Form

Parental Consent Form Parents and legal guardians of minor children must complete this form and return it to the Convoy of Hope Compassion Teams. The information requested is designed to assist in providing for the safety of

More information

Voluntary Waiver, Consent, Release, and Hold Harmless Agreement PLEASE READ THIS AGREEMENT CAREFULLY.

Voluntary Waiver, Consent, Release, and Hold Harmless Agreement PLEASE READ THIS AGREEMENT CAREFULLY. Voluntary Waiver, Consent, Release, and Hold Harmless Agreement PLEASE READ THIS AGREEMENT CAREFULLY. DO NOT SIGN THIS AGREEMENT UNLESS YOU AGREE TO THESE TERMS. RIDING IS VOLUNTARY; YOU ARE NOT REQUIRED

More information

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer: Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,

More information

Riley Equine Center, Inc.

Riley Equine Center, Inc. Dear Prospective Volunteer, Thank you for your inquiry about the volunteer opportunities at Riley Equine Center. We are a not-for-profit organization that uses horses to encourage physical and mental development

More information

Wattle Flat Recreational Reserve Castlemaine

Wattle Flat Recreational Reserve Castlemaine COMBINED TRAINING AND DRESSAGE JACKPOT COMBINED TRAINING AND DRESSAGE JACKPOT Wattle Flat Recreational Reserve Castlemaine 22nd of November 2015 Proudly Sponsored by CASTLEMAINE BENDIGO BENDIGO Pony Club

More information

ACKNOWLEDGEMENT OF RISK ACCEPTANCE OF RESPONSIBILITY RELEASE OF LIABILITY

ACKNOWLEDGEMENT OF RISK ACCEPTANCE OF RESPONSIBILITY RELEASE OF LIABILITY ACKNOWLEDGEMENT OF RISK ACCEPTANCE OF RESPONSIBILITY RELEASE OF LIABILITY This document affects your legal rights. You must read and understand it before initiating and signing. DUTY OF PARTICIPANTS: It

More information

FOR THE LOVE OF LEARNING 3110 SE Aster Lane, Stuart, FL

FOR THE LOVE OF LEARNING 3110 SE Aster Lane, Stuart, FL FOR THE LOVE OF LEARNING 3110 SE Aster Lane, Stuart, FL 34994 772-924-1070 ForTheLoveOfLearningFL@GMail.com 2019/2020 REGISTRATION Student Name: D.O.B.: Age on Sept 2019: Address City State Zip Home Phone#

More information

Sarasota Manatee Association for Riding Therapy, Inc.

Sarasota Manatee Association for Riding Therapy, Inc. Sarasota Manatee Association for Riding Therapy, Inc. 4640 CR 675 E, Bradenton, FL 34211-9600 941-322-2000 www.smartriders.org www.facebook.com/smartriders General Information: Name: Volunteer / Staff

More information

Planning Packet For Group Events

Planning Packet For Group Events Planning Packet For Group Events grizzlyadventures@butlercc.edu 901 S Haverhill Rd El Dorado, KS 66842 316-218-6118 Preparing for Your Challenge Course What to Expect from Your Challenge Course Experience

More information

Dear Team Captains, Managers and Members The waiver consists of : 1. Team Waiver which also acts as the team roster. 2. Combined Team waiver signature page for: Apendix A, B, B1, C 3. Appendix A: Team:

More information

The College of Engineering & Computer Science Webelos Engineering Pin Day Saturday, October 28, 2017

The College of Engineering & Computer Science Webelos Engineering Pin Day Saturday, October 28, 2017 The College of Engineering & Computer Science 2017 Webelos Engineering Pin Day Saturday, October 28, 2017 Registration at 7:30 a.m. - Event runs from 8:00 to 11:15 a.m. University of Evansville Koch Center

More information

Student Domestic Travel Instructions

Student Domestic Travel Instructions Student Domestic Travel Instructions This information is provided to assist University Faculty and Staff members in planning and conducting classroom and/or co-curricular trips. Page 1. This page provides

More information

Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT

Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado 81344 (970) 560-2926 No. LLAMA LEASE AGREEMENT Redwood Llama Company, LLC ( Lessor ) agrees to lease to the Customer named below

More information

1770 Davidson Ave Bronx, NY P F

1770 Davidson Ave Bronx, NY P F Summer Camp 2016 Thank you for your interest in attending Little Scholars Early Development Center Summer Camp. The camp will be for children of the ages 4-12 years old. Along with the many fun filled

More information

2014 Participant Enrollment Application

2014 Participant Enrollment Application 2014 Participant Enrollment Application Participants Information Participant's Name: Date of Birth: / / Age: Weight: Height: Disability: Primary Contact Name: Phone Number: ( ) Check one: ( ) Parent (

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information