IN CONSIDERATION of being permitted to compete, officiate, observe, work for or participate in any way in the EVENTS or being permitted
to enter for any purpose any RESTRICTED AREA (defined as the tech area, hot pit area, track area, spotter area, competition area, staging
area, and any other area within the barriers, fences and/or structures separating the general public from racing activities), EACH OF THE
UNDERSIGNED, for himself/herself, his/her personal representatives, heirs, and next of kin:
1. Acknowledges, agrees, and represents that he/she has inspected or will inspect immediately upon entering any of such RESTRICTED
AREAS, and will continuously thereafter, inspect the RESTRICTED AREAS which he/she enters, and he/she further agrees and warrants that,
if at any time, he/she is in or about the RESTRICTED AREAS and he/she feels anything to be unsafe, he/she will immediately advise the
officials of such and, if necessary, will leave the RESTRICTED AREAS and/or refuse to participate further in the EVENTS; and
2. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE I-10, its parent company and/or related entities and/or
affiliates, the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track
owners, officials, competition vehicle owners, drivers, pit crews, rescue personnel, persons in any RESTRICTED AREA, promoters, sponsors,
advertisers, owners and lessees of premises used to conduct the EVENTS, premises and event inspectors, surveyors, underwriters,
consultants and others who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities
regarding the premises or EVENTS and each of them, their directors, officers, agents, and employees all for the purposes referred to as
"Releasees," FROM ALL LIABILITY TO THE UNDERSIGNED, his/her personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL
LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THERFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN
DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENTS, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES
OR OTHERWISE; and
3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE Releasees and each of them FROM ANY LOSS, LIABILITY,
DAMAGE, OR COST they may incur arising out of or related to the UNDERSIGNED'S INJURY OR DEATH, WHETHER CAUSED BY THE
NEGLIGENCE OF THE RELEASEES OR OTHERWISE; and
4. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to
the EVENTS WHETHER CAUSED BY THE negligence of Releasees OR OTHERWISE; and
5. HEREBY acknowledges that THE ACTIVITIES OF THE EVENTS ARE VERY DANGEROUS and involve the risk of serious injury and/or death
and/or property damage and that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR
PROCEDURES OF THE RELEASEES; and
6. HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of
negligence by the Releasees, INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as is permitted by
the laws of the State or Province in which the EVENTS are conducted and that if any portion thereof is held invalid, it is agreed that the
balance shall, notwithstanding continue in full legal force and effect.
By signing my name below, I assert that I have reviewed and agree to the release above. I UNDERSTAND THAT BY SIGNING
BELOW I AM SIGNING FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE
TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST
EXTENT ALLOWED BY LAW.
Medical Care Statement
By entering my name below, I authorize all medical and surgical treatment, x-ray, laboratory, anesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics and waive my right to informed consent of treatment. I UNDERSTAND THAT BY SIGNING BELOW I AM SIGNING FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
2020 Release of Medical Information
Please read the following medical release carefully. By signing below, you acknowledge that you have both read and understood all text presented to you in this form: To any doctor, nurse, EMT, paramedic, ambulance company, air ambulance company, fire department, EMS agency, chiropractor, hospital, clinic, health insurer, physical therapist, government agency, insurer, employer or any other person, entity, firm, or organization having custody of medical records or medical information pertaining to me, the undersigned person. I, the undersigned person, give my consent and authorize you to give, disclose and release, without restriction, all of my individually identifiable health information and medical records regarding any past, present, or future medial or mental health condition, to include all information relating to the diagnosis and treatment of mental illness, and drug or alcohol abuse separately to the Lucas Oil Off Road Racing Medical Director and/or his/her designee(s). I also consent and authorize you to discuss any medial information with the Lucas Oil Off Road Racing Medical Director. I, the undersigned person, understand that this information may be used to determine my eligibility to race and for follow-up following any significant on-track or other incidents. I also understand that this information may be used by Lucas Oil Off Road Racing to give status updates to the media when deemed appropriate. You should interpret the terms "medical information" and "medical records" broadly to include records, reports, test reports or results, x-rays, lab test results, MRI and CT scans, EKGs, photos, etc. This release, and all authority to disclose information pertaining to me, shall expire two (2) years from the date of the submission of this form unless earlier revoked by me in writing. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC 132d and 45 CFR 160-164. Specifically, this release authority complies with the valid authorization requirements of 45 CFR 164.508 ©. By signing my name below, I assert that I have reviewed and agree to the release above. I UNDERSTAND THAT BY SIGNING BELOW I AM SIGNING FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
2020 Media Release
Please read the following media release carefully. By signing below, you acknowledge that you have both read and understood all text presented to you in this form: For and in consideration of my involvement as a driver in a Lucas Oil Series, hereafter referred to as Lucas Oil event, on the terms hereinafter stated, I hereby give Lucas, their legal representatives and assigns, those for whom Lucas are acting, and those acting with their permission, or their employees, the right and permission to copyright and/or use, reuse and/or broadcast and republish motion picture and videotape recordings of me, in conjunction with my own or a fictitious name, on reproductions thereof in color or black and white made through any media Lucas at their studio or elsewhere, for any purpose whatsoever, including the use of any printed matter in conjunction therewith. I hereby waive any right to inspect or approve the finished motion picture, videotape, sound track, or advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that it might be applied. I hereby release, discharge and agree to save harmless Lucas Oil, their representatives, assigns, employees or any person or persons, corporation or corporations, acting under their permission or authority, or any person, persons, corporation or corporations, for whom they might be acting, including any firm publishing and/or distributing the finished product, in whole or in part, from and against any liability as a result of any distortion, blurring, or alteration, optical illusion, or use in any composite form, either intentionally or otherwise, that may occur or be produced in the taking, processing or reproduction of the finished product, its publication, distribution , or broadcast of the same, even should the same subject me to ridicule, scandal, reproach, scorn, or indignity. I am competent to contract in my own name in so far as the above is concerned. There is no compensation for my appearance or my engagement as a driver in a Lucas Oil event. ALL DRIVERS: By entering my name below, I assert that I have reviewed and agree to the release above. I UNDERSTAND THAT BY SIGNING BELOW I AM SIGNING FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO BE AND INTEND MY ELECTRONIC SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.