| If your minor child is participating in any Bartow Cycle
Sports, Inc. promoted activity, and you as the parent or legal
guardian will not be present at such activity, you must complete the
following form, have it notarized, and made available to Bartow
Cycle Sports Inc.staff at the time of registration. To copy
and print the form, highlight the form content, then right click
your mouse and click on copy. Open your word processor, paste
the form and print it.
Parental Consent
Form
I,
___________________________________, Legal Parent or Guardian of
______________________________give
Permission for
________________________to sign any entry forms, releases forms,
memberships forms or any
other document rerquired
by Bartow Cycle Sports, Inc. or the Race promoter for
_______________________to
Race and/or practice at
the Bartow Cycle Sports, Inc motocross track located at 1585
Centennial Blvd, Bartow,
Fl. 33830.
Each of the undersigned
being fully aware of the risks and hazards inherent upon entering
said premises and/or participating in any races or practices held at
said premises, hereby elects voluntarily to enter upon said
premises, knowing their present conditions and knowing that said
conditions may become more hazardous and dangerous during the time
that each of the undersigned is upon the said premises. Each of the
undersigned hereby voluntarily assumes all risks of loss, damage, or
injury, including death, that may be sustained by any or each of the
undersigned, or any property of any of each of the undersigned while
in, on or upon the said premises.
This release shall be
binding upon the distributees, heirs, next of kin, and personal
representatives of each of the undersigned
I,
____________________________________, Legal Parent or Guardian of
_______________________________give
permission to
_____________________________________to make any medical decisions
in case of emergency at
Bartow Cycle Sports, Inc.
motocross track.
EMERGENCY CONTACT PHONE
NUMBERS
Home (
)______________________
Work (
)______________________
Cell (
)______________________
Other (
)______________________
I swear, or affirm, under
penalty of perjury, that this Parental Consent Form is true and
correct.
_________________________________________________
Signature of Legal
Parent of Guardian
______________________________
affix notary stamp/seal above
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