If your minor child is participating in any Motocross of Marion County promoted activity, and you as the parent or legal guardian will not be present at such activity, you must complete the following form, have it notarized, and made available to Motocross of Marion County staff at the time of registration.  To copy and print the form, highlight the form content, then right click your mouse and click on copy.  Open your word processor, paste the form and print it.

Rider Release Form for Minors 
Signed by Parent(s) / Guardian (s)

That I, (riders name)________________________________________________ , a minor and I/we (parent) _____________________________________ and (parent) ________________________________________ individually and also as parent(s) of the above named minor of ______ (age) years of age for and in consideration of receiving permission from Motocross of Marion County for (riders name) ________________________________________________ a minor to enter upon the premises of this raceway located in Citra, Florida the receipt of such permission is hereby acknowledged, and in further consideration of receiving permission for (rider's name) ________________________________________________ a minor to participate, when qualified either as a rider, mechanic, owner, attendant, or in any other capacity, in any race or practice held at the above mentioned premises the receipt of such permission being also hereby acknowledged, each of the undersigned hereby released Motocross of Marion County, the promoter and its agents, officers, servants, and employees, of and from any and all liability, claims, demands, actions, and causes of actions whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by any or each of the undersigned, or any property of any of the undersigned while in, on or upon the said premises, or any other premises leased to or under the control or supervision of Motocross of Marion County.

    Each of the undersigned being fully aware of the risks and hazards inherent upon entering said premises and/or participating in any races or practices held at said premises, hereby elects voluntarily to enter upon said premises, knowing their present conditions and knowing that said conditions may become more hazardous and dangerous during the time that each of the undersigned is upon the said premises.  Each of the undersigned hereby voluntarily assumes all risks of loss, damage, or injury, including death, that may be sustained by any or each of the undersigned, or any property of any of each of the undersigned while in, on or upon the said premises.

Furthermore, in the event that the below signed parent or guardian are not present, they authorized ____________________________________ to make medical decisions in event that the minor participant is sick or injured.

    This release shall be binding upon the distributees, heirs, next of kin, and personal representatives of each of the undersigned.

    In signing the foregoing Release, each of the undersigned hereby acknowledge and represents:

(A)    That he/she has read the foregoing Release, understands it, and signs it voluntarily;

(B)    That the undersigned parent(s) / guardian(s) is over twenty-one (21) years of age and of sound mind;

(C)    That the undersigned minor is racing or participating on the above mentioned premises with the knowledge and consent of the parent(s) / guardian(s);

(D)    That he/she is not an agent, servant, or employee, of Motocross of Marion County, and/or any of the agents, officers, servants or employees of the promoter.

    The undersigned parent(s) / guardian(s) further for said considerations hereby agrees to protect Motocross of Marion County, it's personal Representatives and assigns any actions, claims, or demands by said minor, or by any other person or persons on account of damages of any character resulting in any way from said racing or practicing on the above mentioned premises by said minor, and we also hereby agree to reimburse and make good to Motocross of Marion County any loss, damages, or costs it may have to pay as a result of any such action, claims or demands.

    IN WITNESS WHEREOF, each of the undersigned has hereunto set his/her hand and seal this_________day of ___________________, 20______.

DRIVER LIC# __________________________________

MINOR'S SIGNATURE________________________________

PARENT/GUARDIAN ________________________________

PARENT/GUARDIAN ________________________________

 NOTARY PUBLIC ________________________________

MY COMMISSION EXPIRES: ________________________

WITNESS ________________________________

Mailing Address (Please Print)

RIDERS NAME________________________________________

ADDRESS___________________________________________

CITY___________________STATE_____ ZIP ______________

AGE_______ DATE OF BIRTH___________________________

 RESIDENT PHONE________________________________

EMERGENCY PHONE_____________________________