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Karl Scott’s MX Schools
105 Country Club Dr. Suite. H Americus, GA
31709
Print this
form and mail to above address with required deposit. Please make check
payable to Karl Scott.
Bike Size _________ Bike
# _____________
Beginner __________ Intermediate ________
Novice ___________ Expert
_______
Date of Class _________/_______/2006
Name__________________________Age_________Date of
Birth_____________
Address____________________________________________________________
Street
City State
Zip
Phone Number ________ - ______________________
E-mail
______________________________________
I hereby declare that it be
my intent while at the Motocross School to drive at high speeds and to test my
driving skills and to check the performance of the vehicle I am driving.
I affirm that I am going to engage in these
potentially dangerous activities of my own volition. I hereby affirm that I
enter this school fully aware of the possible hazards to my person and property
therein. If I am injured, in any manor, while I am in school, or on school
grounds, I will grant a full and unconditional release for any injuries
sustained to my person to all track owners, participants, officials, employees,
promoter, instructors or any others who are responsible for the activities in
the school.
On behalf of myself, my heirs, executors, or
administrators, I agree to hold harmless and indemnify all track owners,
participants, officials, employees, promoters, instructors, or others who are
responsible for the activities in the school for any damages or injury to my
person or property.
READ THE ABOVE CAREFULLY BEFORE SIGNING INTO
SCHOOL
I HAVE READ THIS ENTRY BLANK AND FULLY UNDERSTAND
THE WAIVER
YES _________ NO ___________
IF UNDER 18 YEARS OF AGE, PARENT OR LEGAL GUARDIAN
MUST SIGN
RIDER'S
SIGNATURE__________________________________DATE_______________
PARENT'S
SIGNATURE________________________________DATE_______________
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