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7185 Nicolaus Rd. Lincoln, CA. 95648

WESTCAR

LATE MODEL SERIES

2008 REGISTRATION

Full Name:____________________________________________________________________

Mailing Address:_______________________________________________________________

Address/City/State/Zip Code

Contact Number: (___)_______________ Alternate Contact Number: (___)_______________

Date of Birth: ____/____/____ Social Security Number: ______-______-______

Spouses Name:________________________________________________________________

Signature of Registrant:______________________________________Date:_____/_____/_____

News Media Contact Info

(If Different From Above)

Contact Number: (____)________________ Fax Number: (____)________________

This registration must be completed and returned accompanied by the required fee.

Car Number Desired: _____________ Second Choice: ______________

 Driver $ 100.00

 Crew Member $ 60.00

 Car Owner $ 60.00

* For Official Use Only *

Paid By:  Cash  Check CK # _.

¨ 7185 Nicolaus Rd ¨ Lincoln, Ca. 95648 ¨ (916) 408-4718 ¨ westcarlatemodelseries@msn.com ¨

 

WESTCAR

LATE MODEL SERIES

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

IN CONSIDERATION of being permitted to compete, observe, work, or participate in any way in the EVENT(S) or being permitted to enter for any purpose any RESTRICTED AREA (defined as any area requiring special authorization, credentials, or permission to enter or any area to which admission by the general public is restricted or prohibited) THE UNDERSIGNED, for himself, his personal representatives, heirs, and next to kin:

1. Acknowledges, agrees, and represents that he has or will immediately upon entering any of the such RESTRICTED AREAS, and will continuously thereafter, inspect the RESTRICTED AREAS which he enters, and he further agrees and warrants that, if at any time, he is in or about RESTRICTED AREAS and he feels anything to be unsafe, he will immediately advise the officials of such, and if necessary will leave the RESTRICTED AREAS and/or refuse to participate further in the EVENT(S).

2. HEREBY RELEASES, WAIVES, DISCHARGES, AND CONVENTS NOT TO SUE the promoters, participants, racing associates, sanctioning organization or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any person in any RESTRICTED AREA, promoters, sponsors, advertisers, owners and leassees of premises used to conduct the EVENT(S), premises and event inspectors, surveyors, underwriters, consultants and others who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities regarding the premises or EVENT(S) and each of them, their directors, officers, agents and employees, all for the purposes herein referred to as “releasees,” FROM ALL LIABILITY TO THE UNDERSIGNED, his personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFORE ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATING TO THE EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.

3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them FROM ANY LOSS, LIABILITY, DAMAGE, OR COST they may incur arising out of or related to the UNDERSIGNED’S INJURY OR DEATH, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.

4. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to the EVENT(S) whether caused by the NEGLIGENCE OF RELEASES or otherwise.

5. HEREBY acknowledges that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involves the risk of serious injury and/or death and/or property damage. THE UNDERSIGNED, also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASES.

6. HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the releases. INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as is permitted by the laws of the State or Province in which the Event(s) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEES BEING MADE TO ME AND INTEND MY SIGNING TO BE

A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

SIGNATURE_________________________________________________________________ DATE_______________________________________

PRINT NAME_______________________________________________________________

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ADVERTISING RELEASE

I hereby agree to ANY use of my name or likeness for any print, radio or television advertisement or promotion.

SIGNATURE_________________________________________________________ DATE___________________________________

PRINT NAME_______________________________________________________________

 

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