Pymatuning Holeshot Raceway

1 Race Date

Race Date *

2 Rider Information

First Name *

Last Name *

Date of Birth *

AMA Number *

AMA Expiration Date *

3 Address

Street Address *

City *

State *

Zip *

4 Classes & Vehicle Information

Add one entry per class. Each class can have its own rider number and vehicle details.

5 Waiver & Rider Signature

Release and Waiver of Liability
In consideration of being permitted to participate in any way in the event, I, the undersigned, acknowledge, appreciate, and agree that: The risk of injury from the activities involved in this event is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and I willingly agree to comply with the stated and customary terms and conditions for participation. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Pymatuning Holeshot Raceway, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise. I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

Rider Signature * (sign in the box)

Signature Date *

Race Signup

✓ Registration Submitted!