Car No. __________

NWRC FRIDAY NIGHTER REGISTRATION FORM

Class __________

Novice – SOP – Masters - Unlimited

(Please print clearly)

Driver ________________________________ Navigator ____________________________

Address _______________________________ Address _______________________________

City, Zip _______________________________ City, Zip _______________________________

Phone ___________________ Club _________ Phone ___________________ Club _________

E-Mail Address_______________________ E-Mail Address________________________

Car Year _____ Make _____________ Model __________ Color _________ License Number ___________

Extra Plaques_____ Registration Use $ ________

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RALLY

RELEASE AND WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

Read carefully before signing

Event Name Location Event Date

IN CONSIDERATION of being allowed to participate in any way in any road rally ("the rally"):

1.  I understand and agree that, although I have been supplied with certain information on the prescribed rally course, the nature of the rally does not permit me to inspect the prescribed course or any portion of the prescribe course or the immediately adjacent area thereof with which I may come in contact during the rally prior to my participation in the rally.  I understand and agree that, if at any time, I feel anything to be UNSAFE, I will immediately take all necessary precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further in the rally.

2.  I understand that:

a.  Participation in the rally involves RISKS AND DANGERS, as does any roadway vehicular activity, of serious BODILY INJURY, including permanent DISABILITY, PARALYSIS, and DEATH ("RISKS");

b.  The SOCIAL AND ECONOMIC LOSSES and/or damages, which could result from those, risks COULD BE SEVERE;

c.  These risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others, the rules of the rally, the condition and layout of the prescribed course, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW;

d.  There may be OTHER RISKS NOT KNOWN TO ME or that are not readily foreseeable at this time.

3.  I ACCEPT SUCH RISKS AND RESPONSIBILITIES FOR THE LOSSES AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH, even if caused, in whole or in part, by the NEGLIGENCE OF THE "RELEASEES" NAMED BELOW.

4. I HEREBY RELASE, DISCHARGE AND COVENANT NOT TO SUE the promoters, participants, officials, car owners, drivers, crew members, rescue personnel, sponsors, advertisers, owners and lessees of premises used to conduct the EVENT(S), premises and event inspectors, surveyors, underwriters, consultants and others who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities regarding the premises or EVENT(S) and each of them, their directors, officers, agents, and employees, all for the purposes herein referred to as "Releasees." FROM ALL LIABILITY TO THE UNDERSIGNED, his personal representative, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

PRINT NAME HERE SIGN NAME HERE REGISTRARS INITIALS DATE

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