Route 66 Gurney Tourney Registration Form

     

Quantity
Price
Total
Registration Fee

Registration fee is $25.00 per person or $125.00 per team. Please enter the number of participants.

X
$
25.00=
$
0

Contact Information

Company/Organization*
Team Name*
Team Captain Name*
Phone*
Email*
Confirm Email*
Country*
State / Province*
Address*
City*
*
*
*
*
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*
Date of Birth*

Participant Release of Liability and Assumption of Risk

In consideration of being allowed to participate in any way in the 2017 Route 66 Gurney Tourney event, related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:


1. The risk of injury from participation in the Route 66 Gurney Tourney is possible, and the risk of serious injury does exist;


2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (defined below) or others, and whether or not covered by my personal health or other type of insurance; and I assume full responsibility for my participation in the Route 66 Gurney Tourney;


3. I understand that photographs may be taken of me in connection with the Route 66 Gurney Tourney. I hereby consent to the taking of such photographs and the publication of such photographs;


4. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,


5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE TULSA HOSPITALITY HOUSE, INC. operator of the Route 66 Gurney Tourney, its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises, property and/or equipment used to conduct the event ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, LOSS OR DAMAGE to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
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.

Adult Participant's e-Signature*

Parent/Guardian Waiver for Minors (14-18 years old)

The undersigned parent and natural guardian does hereby represent that he/she is, in face, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties associated with the event, as referenced above, from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.

Minor Participant's e-Signature (if participant is 14-18 years old)
Parent/Guardian e-Signature (if participant is 14-18 years of age)

Payment Information

Amount*
$
Name on Card*
Card Number*

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