DAYTONA BEACH MOTOR SPORTS PARK dba SPEEDPARK
Please fill out one form for each person in your group.
RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
(Print) PARTICIPANT'S NAME ____________________________________________________________________________
(Print) PARENT/ GUARDIAN'S NAME _______________________________________
Tel# ( )_______________________
ADDRESS _______________________________________________________
EMAIL __________________________________
CITY ___________________________________ STATE_______________________ZIP_______________________________
SIGNATURE ___________________________________________________ DATE_____________________________________
(SIGNATURE OF PARTICIPANT OR LEGAL GUARDIAN IF PARTICIPANT IS UNDER AGE 18)
I, the undersigned, hereby acknowledge that I have voluntarily chosen to ride the "PRODRAG NITRO ALLEY AMMUSEMENT RIDE AND/OR, GO-KART AMUSEMENT RIDES." I know and fully understand that riding any of the "Go-karts and Dragster rides" is a dangerous and hazardous activity where serious accidents can occur. I understand that the participants in using vehicles and rides of this nature, and in dealing with different weather conditions, mechanical and electrical apparatuses, employees of unknown skills, and the potential for personal error creates an unknown condition whereby a participant may encounter unanticipated hazards and risks that can result in illness,injury, death and or property damage, whether obvious or not, and can be intensified by the unavailability of immediate medical attention in case of injury.
I acknowledge that the basic operation of the "DRAGSTER AND GO-KARTS AMUSEMENT RIDES" has been explained. I represent that I (or any person on whose behalf I am signing) am physically and mentally fit to participate in this ride, and that the rider has no current or past medical condition, (i.e. heart conditions, back problems, pregnancy, subject to seizures, paralysis, restrictive use of arms
or legs, etc.)That participant has read and fully understands the Important Ride Notice "&" Rules and hereby agrees to follow all rules, regulations and instructions and to act at all times in a civilized and ruly manner.
In consideration for DAYTONA BEACH MOTOR SPORTS PARK allowing me to ride any amusement ride, I represent and promise that I (or any person on whose behalf I am signing), my personal representatives, heirs, next of kin, spouse, members of my family, and assigns voluntarily and expressly agree to release, discharge, covenant not to sue and hold harmless DAYTONA BEACH MOTOR SPORTS PARK, LTD. PARNERSHIP, PRO DRAG LTD PARTNERSHIP, PRO DRAG LLC, AKSHUN "&" AKSHUN, INC., THE
CITY OF DAYTONA BEACH, THE STATE OF FLORIDA, and all owners, officers, directors, members, agents and employees of the above named parties and affiliates from any and all legal liability, property damage and or medical expenses resulting from myparticipation in this ride, and personally assume all risk including but not limited to negligence, strict liability, breach of contract, or any other act or omissions, or any other participants, including myself or from any other cause.
I fully recognize and understand if I (or any minor on whose behalf I am signing this release) am hurt, die or my property is damaged, I am giving up my (our) right to make a claim or file a lawsuit against all parties and affiliates named herein, even if they negligently or by some other act or omission caused the injury or damage.
As a parent or legal guardian of a participant under 18 years of age, I have read and voluntarily agree that said minor may participate in this ride and I sign this release on their behalf. In addition, I give DAYTONA BEACH MOTOR SPORTS PARK dba SPEEDPARK, its agents, employees and associates permission to treat said minor in cases of illness, injury, emergency, or accident. Should emergency or medical services become necessary, the expenses are the sole responsibility of the participant and not that of any other party or affiliate named herein.
I have read this document, and understand that this is a full and complete release of all claims for all liability. I understand that I am assuming all risks inherent in riding "PRO DRAG NITRO ALLEY DRAGSTERS AND ALL SPEEDPARK GO-KART AMUSEMENT RIDES, ARCADE GAMES AND ALL OTHER AMUSEMENT RIDES." I voluntarily sign my name as evidence of my acceptance of the above provisions and agree to be bound by the terms of this agreement. I acknowledge that DAYTONA BEACH MOTOR SPORTS PARK dba SPEEDPARK could use my e-mail address for marketing purposes and will not share this information with any other entity.
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