IN CONSIDERATION of my minor child (“the Minor”) being permitted to participate in any way in the EVENT(S) and/or being permitted to enter for any purpose any RESTRICTED AREA(S) (defined to be any area which requires special authorization, credentials or permission to enter or any area to which admission by the general public is restricted or prohibited), I agree:
1. I know the nature of the EVENT(S) and the Minor’s experience and capabilities and believe the Minor to be qualified to participate in the Event(s). I will inspect the premises, facilities and equipment to be used, or with which the Minor may come in contact. IF I OR THE MINOR BELIEVE ANYTHING IS UNSAFE, I WILL INSTRUCT THE MINOR TO IMMEDIATELY LEAVE THE RESTRICTED AREA AND REFUSE TO PARTICIPATE FURTHER IN THE EVENT(S).
2. I FULLY UNDERSTAND and will instruct the Minor that: (a) THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS AND PARTICIPATION IN THE Event(s) and/or entry into Restricted Areas involves RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“Risks”); (b) these Risks and dangers may be caused by the Minor’s 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, and/or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS NOT KNOWN TO ME or that are not readily foreseeable at this time; (d) THE SOCIAL AND ECONOMIC LOSSES and/or damages that could result from those Risk(s) COULD BE SEVERE AND COULD PERMANENTLY CHANGE THE MINOR’S FUTURE.
3. I consent to the Minor’s participation in the Event(s) and/or entry into restricted areas and HEREBY ACCEPT AND ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES, COSTS AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH, EVEN IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW.
4. I HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any Restricted Area, sponsors, advertisers, owners and lessees of premises used to conduct the Event(s), premises or Event inspectors, surveyors, underwriters, consultants and other persons or entities who give recommendations, directions or instructions or engage in risk evaluation or loss control activities regarding the premises or Event(s) and each of them, their directors, officers, agents, employees, representatives, owners, members, affiliates, successors and assigns, all for the purposes here referred to as “Releasees”, FROM ALL LIABILITY TO ME, THE MINOR my and the minor’s personal representatives, assigns, heirs, and next of kin, FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON ACCOUNT OF ANY INJURY TO ME OR THE MINOR, including but not limited to, death or damage of property, CAUSED OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE.
5. If, despite this release, I , the Minor, or anyone on the Minor’s behalf, makes a claim against any of the “Releasees” named above, I AGREE TO DEFEND, INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST THEY MAY INCUR DUE TO THE CLAIM MADE AGAINST ANY OF THE “RELEASEES” NAMED ABOVE, WHETHER THE CLAIM IS BASED ON THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE.
6. I sign this agreement on my own behalf and on behalf of the Minor.
I HAVE READ THIS PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT. I UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I AND/OR THE MINOR WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT.
I hereby certify that I am the parent and/or guardian of the driver, a minor under the age of eighteen years, and in consideration of value received, the receipt of which is hereby acknowledged, 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 for my child and waive my right to informed consent of treatment. This waiver applies only in the Event that neither parent/guardian can be reached in case of an emergency. I understand that by signing I am authorizing all of the above and sign it voluntarily and without inducement.
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 ©.
I hereby certify that I am the parent and/or guardian of the driver, a minor under the age of eighteen (18) years, and in consideration of value received, the receipt of which is hereby acknowledged, I have read this Release and understand that by signing it I am authorizing all of the above and sign it voluntarily and without inducement.
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.
I hereby certify that I am the parent and/or guardian of the driver, a minor under the age of eighteen years, and in consideration of value received, the receipt of which is hereby acknowledged, I have read this Release and understand that by signing it I am authorizing all of the above and sign it voluntarily and without inducement.