Ama Minor Annual Release (Page 3 of 3) in pdf

Ama Minor Annual Release Page 3

MINOR’S ASSUMPTION OF RISK ACKNOWLEDGEMENT

ALL AMA/ATVA EVENTS, ACTIVITIES AND/OR LOCATIONS

2009 DATES

I have obtained the consent of my parents/guardians to participate in the above EVENT(S). I understand that I am

assuming all of the risks if I get hurt during the EVENT(S) and I state the following:

My parents and I believe I am qualified to participate in the EVENT(S). I will inspect the premises and

equipment and if, at any time, I feel anything to be unsafe, I will immediately leave and refuse to

participate further in the EVENT(S).

My parents/guardians have explained to me and I understand that there are risks and dangers associated

with participation in the EVENT(S) and admission within the RESTRICTED AREA that could cause severe

bodily injury, disability and death.

My parents/guardians have explained to me and I understand that these risks and dangers may be caused

by my own actions or inactions, the actions or inactions of others participating in the EVENT(S), the

rules of the EVENT(S), the condition and layout of the premises and equipment, or the negligence of

others, including those persons responsible for conducting the EVENT(S).

I HAVE READ THE ABOVE ASSUMPTION OF RISK ACKNOWLEDGEMENT, UNDERSTAND WHAT I HAVE READ,

AND SIGN IT VOLUNTARILY.

I HAVE READ THIS RELEASE

SIGNATURE OF MINOR PARTICIPANT

DATE

PRINTED NAME OF MINOR PARTICIPANT

AGE

ADDRESS

I HAVE READ THIS RELEASE

SIGNATURE OF WITNESS (Parent/Guardian)

PRINTED NAME OF WITNESS

Receipt or AMA/ATVA Number (receipt number located on upper right of application)

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Ama Minor Annual Release Page 3