Sportsman Super Series

P.O. Box 976

Antigonish, Nova Scotia, B2G 2S3

(902) 971-0416 902-971-0419 Fax (902) 863-4235

www.riversidesportsmansuperseries.com

 

2011 SPORTSMAN SUPERSERIES Tour

 

Registration Form/ Insurance Waiver

IMPORTANT: Please complete legibly and in full and submit with $150.00 registration fee.  The first 28 drivers to register will receive front row parking at Riverside Speedway.

 

Team Information

CAR OWNER NAME: __________________________________

CAR OWNER MAILING ADDRESS: ______________________

CAR OWNER PHONE: ________________________________

HOME:________________________________________

WORK:________________________________________

CELL:_________________________________________

FAX:___________________________________________

CAR OWNER E-MAIL ADDRESS:______________________

MAKE CHEQUES PAYABLE TO (circle one): CAR OWNER  / DRIVER

PRIMARY SPONSOR: __________________________________

ASSOCIATE SPONSORS:_______________________________

CAR YEAR, MAKE & MODEL:__________________________

CAR NUMBER : __________________________

Driver Information

NAME:______________________________________________

MAILING ADDRESS:__________________________________

PHONE (Home): (Work):______________________________

CELL: E-MAIL:_______________________________________

PLACE OF BIRTH: _____________________________________

EMERGENCY CONTACT (Name/Number/Relationship):

______________________________________________________

 

 

 

 

 

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

BY SIGNING THIS DOCUMENT YOU WILL WAVE CERTAIN LEGAL RIGHTS. PLEASE READ CAREFULLY!

Description of events(s) covered, herein collectively called the "TOUR": All events sanctioned by and/or promoted by Sportsman Super series.  In full or partial consideration for allowing me to participate in, all related events and activities of the TOUR, I hereby warrant and agree that:

1. I am familiar with and accept that there is the risk of serious injury and death in participation, whether as a competitor, student, official or worker, in all forms of motor sport and in particular in being allowed to enter, for any reason, any restricted area; and

2. 1 have satisfied myself and believe that I am physically, emotionally and mentally able to participate in this TOUR, and that My protective clothing, gear and equipment is fit and appropriate for my role as a participant in the TOUR; and

3. I understand that all applicable rules for participation must be followed including the 2011 Sportsman Super series Tour Tech Rules and the 2011 Sportsman Super series Tour Procedures, regardless of my role and that at all times during the TOUR the sole responsibility for my personal safety remains with me; and

4. I acknowledge that I have read the 2011 Sportsman Super Series Tour Tech Rules and agree to be bound by them. I understand and accept that I am soley responsible for ensuring that I fully comply with the Rules and Procedures; and

5. I will immediately remove myself from participation, and notify the nearest official, if at any time I sense or observe any unusual hazard or unsafe condition or if I feel that I have experienced any deterioration m my physical, emotional or mental fitness, or that of protective clothing, gear or equipment, for continued safe participation in the TOUR.

I UNDERSTAND AND AGREE, ON BEHALF OF MYSELF, MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN THAT MY EXECUTION OF THIS DOCUMENT CONSTITUTES:

1. AN UNQUALIFIED ASSUMPTION BY ME OF ALL RISKS associated with my participation in the TOUR even if arising from the negligence or gross negligence, including any compounding or aggravation of injuries caused by negligent rescue operations or procedures, of the Releases, as that term is defined below, and any persons associated therewith or otherwise participating in the TOUR in any capacity, and

2. A FULL AND FINAL RELEASE AND WAIVER OF LIABILITY AND ALL CLAIMS that I have, or may in the future have, against any person(s), entities organizations(s) associated in any way with the TOUR including the track owners and lessees, promoters, sanctioning bodies, racing associations, or any subdivision thereof, track operators, sponsors, advertisers, car owners and other participants, rescue personnel, event inspectors, underwriters, consultants and others who give recommendations, directions or instructions or engage in risk evaluation and loss control activities, regarding the TOUR or event premises, or anyone or more of them and their respective directors, officers, employees, guides, contractors, agents and representatives (all of whom are collectively referred to as "the Releases") from any and all liability for any loss, damage, injury or expense that I may suffer as a result of my use of or my presence at event facilities or my participation in any part of, or my presence many capacity at, the TOUR, due to any cause whatsoever, INCLUDING NEGLIGENCE, GROSS NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE RELEVANT CCCUPIERS LIABILITY ACT ON THE PART OF THE RELEASEES.

3. AN AGREEMENT NOT TO SUE THE RELEASEES for any loss, injury, costs or damages of any form or type, howsoever caused or arising, and either directly or indirectly from my participation in any aspect(s) of the TOUR, and 4. AN AGREEMENT TO INDEMNIFY, and to SAVE and HOLD HARMLESS the RELEASEES, and each of them, from any litigation expense, legal fees, liability damage, award or cost, of any form or type whatsoever, they may incur due to any claim made against them or anyone of them by me or on my behalf, or that of my estate, whether the claim is based on the negligence or the gross negligence of the Releasees or otherwise as stated above.

5. AN AGREEMENT that this document be governed by the laws, and in the courts, of the Province in which the TOUR event(s) occurs. In consideration of acceptance of this application/ registration/ waiver, the undersigned agree to abide by all rules and regulations as published in the 2011 Sportsman Super series Tour rules and procedures and/or amendments made to such. The undersigned consents to the use, without charge, of his/her name and/or pictures of himself/herself and his/her car, for promotional purpose.

FEE: This application should be accompanied by a registration fee for 2011 of $150.00 made payable:  to Sportsman Super series GOOD FAITH PLEDGE: The undersigned acknowledge the support and effort of racing fans, sponsors, the media, the tracks and the Promoter and agree they will compete on a best effort basis. The undersigned additionally agrees to notify Sportsman Super series Tour if they will not be competing in any event of the TOUR, realizing time is of the essence in this matter.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN SUBSTANTIAL LEGAL RIGHTS WHICH I AND MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES. I SIGN THIS DOCUMENT VOLUNTARILY AND WITHOUT INDUCEMENT.

 

 

CAR OWNER SIGNATURE: _________________________________

DRIVER SIGNATURE: ______________________________________

DATE: ________________________