MOTTVILLE SPEEDWAY REGISTRATION (:CIRCLE YOUR CLASS)
COMPACT BOMBER HORNET CAR#_____________
3. Driver Name Phone Soc Sec #
Mailing Address City State ZIP
Driver Date of Birth Check if Roookie____ WHO GETS 1099 FORM?
If not driver ADDRESS: ______City_______________St. _____Zip__________ SS#______________________
All drivers must have made for racing helmet and at least long sleeved shirt but full driving suit is strongly recommended! Racing gloves required! Visible number required for scoring. No radios. 100 decibel max rule. No consumption of alcoholic beverages by any driver or crew member on track property at any time. No refunds for any reason at any time! Pay-offs held for one week only and paid on a race night only-never mailed! Driver must have signed “release and wavier of liability and indemnity agreement” to be paid and anyone under age of 18 entering the pits must have on file a “MINOR RELEASE AND WAVIER OF LIABILITY AND INDEMNITY AGREEMENT” signed by a parent or legal guardian of the minor which releases the track from all liability for any and all injuries to the minor. No minor may enter pit area unless with a responsible adult.
I fully agree to abide by the rules and regulations of the Mottville Speedway. I acknowledge that I have received a copy of the rules and I fully understand that all decisions of track officials are final!
• I understand, accept and agree that no ambulance or medical staff is on site.
• I accept emergency equipment and staff as adequate.
• I fully understand that I am racing at my own risk.
• I understand that if I am disqualified for rough driving, unsportsmanlike conduct, an illegal car, drinking in the pits, speeding in the pits or any other form of disqualification that I will be paid nothing for the night!
• I fully understand that the TIMING TOWER is off limits to all drivers, crew member, car owners during the racing program and that any violation will result in suspension and/or fine as determined by track officials.
• I understand that this registration can’t be transferred and can not be sold.
• I fully understand that racing is by its very nature a very dangerous sport and I agree to hold totally blameless the Mottville Speedway, its owners and track officials for any and all injuries suffered by me.
• In the event of my death I direct my estate to take no legal action against the Mottville Speedway, its owners or track officials.
I HAVE READ AND I FULLY UNDERSTAND THIS AGREEMENT AND AGREE TO ABIDE BY IT!
Driver Signature Date Print Name
Car Owner Signature Date Print Name
If driver is under 18 years of age I, the parent or legal guardian of the driver, by signing below agree that I have read the above agreement and will abide by it and that I have signed the MINOR RELEASE AGREEMENT for the season and that I assume all responsibility for any and all injuries suffered by the above named minor. I fully understand that track does not promote the driving of race cars/karts by minors but will allow it based on my assumption of the risk.
Parent/Legal Guardian Signature Date Print Name
MAIL TO: POB 207,NAPPANEE, IN. 46550
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