2009 Pierce County Fair Truck Pull Registration Form

Friday, August 14th – 7:00pm
Ellsworth, WI

 

 

NAME: ______________________________________________________________________

 

ADDRESS: __________________________________________________________________

 

CITY: ________________________________  STATE: _________________ ZIP: ________

 

YEAR: ________ MAKE: _____________ MODEL: ___________  COLOR: ___________

 

ENGINE SIZE: ___________________ VEHICLE’S NAME: ________________________

 

PITMAN: __________________________________________

 

ENTRY FEE $20.00 PER CLASS FOR DRIVER & (1) PITMAN, each additional = $6

 

CLASS

 

5500# Local Stock          _________

 

6200# Local Stock          _________

 

5500# Improved Stock   _________

 

6200# Improved Stock   _________

 

5500# Street Legal         _________

 

6200# Street Legal         _________

 

5500# Street Mod          _________

 

6200# Street Mod          _________

 

5500# FWD MOD           _________

 

6200# FWD MOD           _________

 

4000# Open Class                   _________

 

8000# Diesel                  _________

 

BY VILLAGE OF ELLSWORTH ORDINANCE, NO ALCOHOLIC BEVERAGES ARE ALLOWED ON THE FAIRGROUNDS DURING THE PIERCE COUNTY FAIR!  IF ANYONE IS CAUGHT WITH ALCOHOL, THEY WILL BE ASKED TO LEAVE and/or ESCORTED OFF BY POLICE PERSONNEL and WILL BE INELIGIBLE TO PARTICIPATE IN THE NEXT YEARS PULL!

g:/entertain/trkreg.frm  revised 4-15-09

 

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

 

Description and location of Truck Pull at the Pierce County Fairgrounds, In the Village of Ellsworth, Wisconsin, On 8/14/09.

 

            In consideration of being permitted to enter for any purpose any RESTRICTED AREA (herein defined as including but not limited to the racing surface, pit areas, infield, burn out area, approach area, shut down area and all walkways, concessions and other area appurtenant to any area where any activity related to the event shall take place), or being permitted to compete, officiate, observe, work for, or for any purpose participate in any way in the event.  THE UNDERSIGNED, for himself, his personal representatives, heirs and next of kin, acknowledges, agree and represents that he has, or will immediately upon entering any of such restricted areas, and continuously thereafter, inspect such restricted areas and all portions thereof which he enters and with which he comes in contact, and he does further warrant that his entry upon such restricted area or areas and his participation, if any, in the event constitutes an acknowledgment that he has inspected such restricted area and that he finds and accepts that same as being safe and reasonably suited for the purpose of his use, and he further agrees and warrants that if, at any time, he is in or about restricted areas and he feels anything to be unsafe, he will immediately advise the officials of such and leave the restricted area.

           

  1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the promoter, participants, racing association, sanctioning organization or any subdivision thereof, track operator, track owner, officials, car owners, drivers, pit crews, any person in restricted area, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the event and each of the, their officers and employees, all for the purposes herein referred to as “release”, from all liability to the undersigned, his personal representatives, 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, whether caused by the negligence of the releases or otherwise while the undersigned is in or upon the restricted area, and/or, competing, officiating in, observing, working for, or for any purpose participating in the event. 

  2. HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from loss, liability damage, or cost that may incur due to the presence of the undersigned in or upon the restricted area or in any way competing, officiating, observing, or working for, or for any purpose participating in the event and whether caused by the negligence of the releases or otherwise.

  3. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releases or otherwise while in or upon the restricted area and/or while competing, officiating, observing, or working for or for any purpose participating in the event. 

THE UNDERSIGNED expressly acknowledges and agrees that the activities of the event are very dangerous and involve the risk of serious injury and/or death and/or property damage.  THE UNDERSIGNED further expressly agrees that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State in which the event is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 

 

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

 

            Dated at Ellsworth, Wisconsin, this _______________ day of August 2009.

 

 

 

 

Signature ________________________________________________