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Arkansas 500 2019

WAIVER AND RELEASE OF LIABILITY

Turpentine Creek Wildlife Refuge, which includes its officers, directors, owners, employees, contractors, affiliates, or agents (“TCWR”), has discussed the risks and potential dangers inherent in attending a dual-sport ride. I certify that I am physically fit, have sufficiently prepared for participation in this visit. I certify that there are no health-related reasons or problems which preclude my participation in this activity. In consideration of my being allowed to enter the Arkansas 500, I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS RIDE, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

By Signing Below, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE TCWR and Scott Smith, Tanya Smith, and Victor Smith from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me as a result of this activity; and

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE TCWR, Scott Smith, Tanya Smith, and Victor Smith from any and all liabilities or claims, including attorneys’ fees, made as a result of participation in this activity, whether caused by the negligence of release or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

Acknowledgment of Understanding: I HAVE READ THIS WAIVER OF LIABILITY, FULLY UNDERSTAND ITS TERMS, AND I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE TCWR, Scott Smith, Tanya Smith, and Victor Smith FOR ANY DAMAGES SUSTAINED. I ACKNOWLEDGE THAT I AM SIGNING THE AGREEMENT FREELY AND VOLUNTARILY, AND I INTEND BY MY SIGNATURE FOR THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED BY LAW.

BY SIGNING BELOW, I EXPRESSLY AGREE THAT THIS WAIVER, RELEASE, AND HOLD HARMLESS AGREEMENT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAW OF THE STATE OF ARKANSAS AND THAT IF ANY PORTION THEREOF IS HELD INVALID, IT IS AGREED THAT THE BALANCE SHALL, NOTWITHSTANDING, CONTINUE IN FULL LEGAL FORCE AND EFFECT. 

Today's Date: November 15, 2019

First Rider Name

First Name*

Last Name*
First Rider Date of Birth*
I certify that I am 18 years of age or older
First Rider Signature*
Second Rider Name

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Second Rider Date of Birth*
Third Rider Name

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Third Rider Date of Birth*
Fourth Rider Name

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Fourth Rider Date of Birth*
Fifth Rider Name

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Fifth Rider Date of Birth*
Sixth Rider Name

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Sixth Rider Date of Birth*
Seventh Rider Name

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Seventh Rider Date of Birth*
Eighth Rider Name

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Eighth Rider Date of Birth*
Ninth Rider Name

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Ninth Rider Date of Birth*
Tenth Rider Name

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Tenth Rider Date of Birth*
Parent or Guardian's Email Address

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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

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Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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