IN CONSIDERATION FOR THE BELOW MINOR BEING PERMITTED BY FARMLANE CAMPGROUND LLC TO PARTICIPATE IN THE ACTIVITES OF SPEED AND ACTION EVENTS
WHICH INCLUDE, WITHOUT LIMITATION, THE USE OF IT'S SERVICES, FACILITES AND EQUIPMENT, I AGREE TO THE FOLLOWING WAIVER, RELEASE AND INDEMNIFICATION:
THE UNDER SIGNED PARENT, GUARDIAN, OR CUSTODIAN OF THE BELOW MINOR, FOR HIS OR HER SELF AND ON BEHALF OF SAID MINOR, HEREBY JOINS IN THE FOREGOING WAIVER AND RELEASE AND HEREBY STIPULATES AND AGRRES TO SAVE AND HOLD HARMLESS,INDEMNIFY, AND FOREVER DEFEND FARMLANE CAMPGROUND LLC, DONALD WALZ AND LAVERNE WALZ, THEIR DIRECTORS, OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS FROM AND AGAINST ANY CLAIMS, ACTIONS, DEMANDS, EXPENSES, LIABLITIES (INCLUDING REASONABLE ATTORNEY FEES) AND NEGLIGENCE MADE OR BROUGHT BY SAID MINOR OR BY ANYONE ON BEHALF OF SAID MINOR, AS A RESULT OF SAID MINORS PARTICIPATION IN THE ACTIVITIES OF SPEED AND ACTION EVENTS AND HIS OR HER USE OF THE PROPERTY AND FACILITIES OF FARMLANE CAMPGROUND LLC, DONALD WALZ OR LAVERNE WALZ. I, FOR MYSELF AND ON BEHALF OF SAID MINOR, FURTHER AGREE NOT TO SUE FARMALNE CAMPGROUND LLC, DONALD WALZ OR LAVERNE WALZ AS A RESULT OF ANY INJURY, PARALYSIS OR DEATH THAT SAID MINOR SUFFERS IN CONNECTION WITH HIS OR HER PARTICIPATION IN THE ACTIVITES OF SPEED AND ACTION OR EVENTS. I ALSO TESTIFY SAID MINOR HAS ATTAINED THE AGE OF AT LEAST 14 YEARS OF AGE.
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DATE SIGNATURE OF PARENT, GUARDIAN OR
CUSTODIAN OF MINOR
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PRINT NAME OF MINOR
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WITNESSED BY
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AGE OF MINOR