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East End Kart Racing
2007 Season Membership-Waiver of Liability-Consent Form-Please Print All Entries Clearly:

Last Name ________________________________________ First _____________________________

Address ___________________________________________________________________________
                    # and Street                                   Town                                      State                                       ZIP

Age _____ Date of Birth ____________ Phone (      ) _______________  Years of Kart Racing_________

Kart # _____  Division (s)______________________________________________________________
PERSONS TO NOTIFY IN CASE OF EMERGENCY:

1 _____________________________________ Relation_____________ Phone (      ) ______________

2 _____________________________________ Relation_____________ Phone (      ) ______________

I, the undersigned, have read, understand, and agree to the following conditions of membership and participation in the racing related events of the EAST END KART RACING.
1-Motor racing and the related activities are potentially dangerous events.
2-I realize that I and my family risk the possibility of serious injury or death as a result of participating and/or attending these activities and events.
3-I agree not to hold responsible or bring lawsuit against the EAST END KART RACING, ANY OF IT'S MEMBERS, PARTICIPANTS, OFFICIALS, EMPLOYEES, TRACK OPERATORS, AND/OR OWNERS, OR THE      SANCTIONING BODY TO RECOVER DAMAGES AS A RESULT OF INJURY, DEATH OR PROPERTY DAMAGE WHICH MAY RESULT FROM PARTICIPATING IN ANY MANNER, IN THE RACING OR RELATED EVENTS AND/OR ACTIVITIES.
4-I agree to abide by the rules of the sanctioning body and the EAST END KART RACING.
5-I realize and agree to, conduct myself in a responsible and sportsmanlike manner at all times to serve as an example to the the numerous young people present at these events.
6-I agree to inspect the racing facility, and bring to the attention of the officials any condition which I feel is unsafe, and further agree to leave the premises if the unsafe condition is not corrected to my satisfaction.
7-I understand that if  I do not observe the rules of the EAST END KART RACING my membership and participation in the events may be terminated.

____________________________________       _____________________________________
Print your name above                                                   Print name of parent or legal guardian if under 18

____________________________________       _____________________________________
Legal signature in ink                                                     Parent or guardian's legal signature in ink

Membership fee:    Drivers......................................................................................$50.00
                                 Crew (entitles you to vote on club matters)........................$15.00
Send this completed form with a check made out to East End Kart Racing to:  Linda Solomito, 236 Brookville Avenue, Islip, NY 11751
NOTE: Birth certificates must accompany ALL minor applications in order to race.
 

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