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 the Bartow Cycle Sports Inc. staff at the time of registration.

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Parental Consent Form

I, ___________________________________, Legal Parent or Guardian of ____________________________ givePermission for ________________________ to sign any entry forms, release forms, memberships forms or another 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 distributes, 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

Email: Tim@BartowMotocross.com

Bartow Cycle Sports, Inc
1585 Centennial Blvd.
Bartow, FL 33830

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