Soap Box Derby Event Waiver
Lions Club Soap Car Derby Event Participant Waiver and Release of Liability
Participant Information:
- Name: ______________________________________
- Age Category: [ ] 7-10 [ ] 11-15
- Address: ______________________________________
- City: _______________________ State: _________ ZIP: __________
- Phone: _________________________
- Email: __________________________
Emergency Contact Information:
- Name: ______________________________________
- Relationship: ___________________________
- Phone: _________________________
Waiver and Release:
I, the undersigned participant, or parent/guardian of the participant if under 18 years of age, hereby agree to the following terms and conditions as a condition for participation in the Lions Club Soap Car Derby Event (hereinafter referred to as “the Event”).
- Acknowledgement of Risks:
- I understand and acknowledge that participating in the Event involves inherent risks, including but not limited to physical injury, property damage, and other unforeseen risks.
- Assumption of Risk:
- I voluntarily assume all risks associated with participation in the Event, including but not limited to those risks outlined above.
- Release of Liability:
- I, on behalf of myself, my heirs, executors, administrators, and assigns, hereby release, discharge, and hold harmless the Lions Club, its officers, directors, volunteers, sponsors, and any other entities associated with the Event from any and all claims, demands, actions, or causes of action arising out of or in connection with my participation in the Event, including but not limited to any injuries, damages, or losses.
- Indemnification:
- I agree to indemnify and hold harmless the Lions Club and all related parties from any claims, damages, losses, and expenses, including legal fees, arising out of my participation in the Event or any breach of this waiver.
- Medical Treatment:
- In the event of an emergency, I hereby consent to receive medical treatment deemed necessary by medical personnel and agree to be responsible for any associated costs.
- Compliance with Rules:
- I agree to abide by all rules, regulations, and instructions provided by the Lions Club and Event officials. I acknowledge that failure to comply may result in disqualification from the Event.
- Media Release:
- I grant permission to the Lions Club to use photographs, videos, and other media of me taken during the Event for promotional purposes without compensation.
- Parental/Guardian Consent:
- If the participant is under 18 years of age, the undersigned parent/guardian consents to the participant’s involvement in the Event and agrees to all terms and conditions of this waiver.
By signing below, I acknowledge that I have read, understood, and agree to the terms and conditions of this waiver and release of liability.
- Participant Signature: _____________________________________ Date: ___________
- Parent/Guardian Signature (if under 18): _______________________ Date: ___________
- Printed Name of Parent/Guardian: ______________________________________
Witness:
- Witness Signature: _____________________________________ Date: ___________
- Printed Name of Witness: ______________________________________
Lions Club Soap Car Derby Event Contact Information:
- Lions Club Contact Person: ________________________
- Phone: _________________________
- Email: __________________________
Thank you for your participation and cooperation. We look forward to a safe and enjoyable event!