Gogebic County Fair 2016
Dirt Dash Waiver
OFFICIAL ENTRY BLANK DIRT DASH CONTESTANT, PIT CREW RELEASE FORM (AND UNDERAGE / 16
or 17 years of age) PARTICIPANT RELEASE
1. Date:_08-28-16_________ Show Location:__Gogebic County Fair – Grandstand – Ironwood, MI_
2. Agreement: As Consideration for being allowed to participate and/or compete in the Dirt Dash Competition,
the undersigned
Driver's Name _____________________________________________
Street Address _____________________________________________
City_______________________ State________ Zip_________ agrees to the following:
3. Acknowledgement of Risk: The undersigned acknowledges that Dirt Dash competition are dangerous
activities and that the participation in an extreme truck competition, as with a contestant, an employee or
volunteer, exposes the participant to a substantial and serious risk of property damage, personal injury or
death. The undersigned expressly acknowledges that his/her participation in the Dirt Dash competition will
involve such a hazard.
4. Release of Sponsors: the undersigned, being fully aware that participation in the Dirt Dash competition
will expose him/her to a substantial and serious risk of property damage and/or personal injury or death,
hereby releases Gogebic County Fair from liability for any and all property damage, personal injuries or other
claims arising from the undersigned's participation in the Dirt Dash competition or discharged by the
undersigned.
5. Covenant Not to Sue: The undersigned covenants that the undersigned shall not now or at any time in the
future, directly or indirectly, commence or prosecute any action, suit or other proceeding against the sponsor
(or the officers, directors, employees, agents or affiliates) concerning arising out of, or related to the actions,
cases of action, claims and demands hereby waived, released or discharged by the undersigned.
6. Assurances: The undersigned has full power, authority, capacity, and right without limitation to execute,
deliver and perform this release.
7. Binding Effect: This release shall be binding upon the undersigned and the undersigned's spouse, legal
representative, heirs, successors, and assigns.
8. I state that I have NOT carried in any alcoholic beverage.
This release has been carefully and fully read by the undersigned and the undersigned fully understands its
terms and conditions and has voluntarily executed and delivered this release as of the_________day
of______________A.D. 20___ •
Driver-Date of Birth __ /_ _/__ , Age____
__________________________________________________
Driver Signature
Note: DRIVER'S & PIT CREW 16 & 17 RELEASE AND CONSENT FORM
I,____________________________, have read the above release in full. I fully understand its terms and
conditions and I hereby voluntarily execute and deliver this consent to ______________________________'s
participation in the extreme truck competition. I further agree to be fully bound by the release's terms and
conditions In both my individual capacity as parent or legal guardian (as determined by a Court Order) for the
above signed._____________________________ (Signature of Parent or Legal Guardian)
Subscribed and sworn this_________day of______________A.D. 20___
Notary Public___________________________________________(signature)
County