Minor Rider Information/Release

Mesquite Hills Mx Park     8150 W Hwy 80     Abilene, Texas 79603

325-691-9036

Rider’s Full Name__________________________________

Age ______  Date of Birth_______________

Address ________________  City _______________

 State___________  Zip_______

Mothers Name___________________________

Fathers Name____________________________

Name ___________________________________

Relationship to rider ________________

Phone number to be called in case of emergency _____________________

In consideration of allowing the below named child to operate a motorcycle, or pit vehicle of any type, and the use by the child of the premises and the property of Mesquite Hills Mx Park, the undersigned, being the legal and acting guardian of the child, acting for themselves and on behalf of the child release and hold harmless Mesquite Hills Mx Park it's owners, sponsors, officers and employees of and from any and all liability, claims, actions and causes of actions whatsoever, arising out of or relating to any loss, damage, injury or death that may be sustained by the child while in, on, or upon the premises of Mesquite Hills Mx Park.

Medical Attention: The undersigned, being duly aware of the risks and hazards inherent upon participation in the classes, activities, and events being conducted by Mesquite Hills Mx Park, and acting for themselves and the child , hereby elect to voluntarily enter upon said premises under the control of Mesquite Hills Mx Park, knowing it's present Condition. The undersigned acting for themselves and the child, hereby voluntarily assume all risks of loss, damage, injury or death that may be sustained by the child while in said premises described above. In the event of any accident which may require immediate medical/dental or any other emergency attention care, in which the legal guardian cannot be notified in a reasonable amount of time through reasonable measures, I hereby authorize Mesquite Hills Mx Park to take all necessary actions as it relates to immediate medical training, attention, transportation, and emergency medical services as warranted in the course of care of the undersigned child. I realize that I will be responsible for all fees and expenses as they may relate to this medical attention paragraph.

Waiver and Release: I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with the operation of motorcycles, or pit transportation equipment. I further agree that Mesquite Hills Mx Park along with it's employees, agents, officers and directors shall not be liable for any losses, expenses, or damages occurring as a result of the below named child's participation in the class, activities, or event except where such loss or damage is the result of the intentional or reckless conduct of one of the groups or individuals identified above.

Acknowledgment: This release shall be binding upon distributees, heirs, next of kin, executors, and administrators of the child and the undersigned. In signing this release, the undersigned hereby acknowledges:

a) That he or she has read this release, understands it and signs it voluntarily

b) That the undersigned signing as legal guardian are true legal guardians

c) That this release shall continue in effect each and every time my child operates a motorcycle, or pit transportation equipment at Mesquite Hills Mx Park.

Legal Guardian's Signature_____________________________________________________ Date___________________

Legal Guardian's Name (Print) __________________________________________________ Phone__________________