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ROUTE 377 GO KARTS, LLC 

2021  

PLEASE READ CAREFULLY 

LEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT 

By signing this document you will waive certain legal rights including the right to sue!

In consideration of Route 377 Go-Karts LLC permitting me to participate in its activities, permitting me the use of its equipment and permitting me the use of its facilities, I hereby release Route 377 Go-Karts LLC, its members, agents, employees, successors, or assigns, from any and all liability, claims demands, actions, and causes of action whatsoever, whether foreseen or unforeseen, arising out of or related in any way to my renting and operating a go-kart at the Route 377 Go-Karts LLC that may result in injury, death or property damage or loss or other damages to me or my family, estate, heirs, or assigns, and further to save and hold harmless Route 377 Go-Karts LLC , it’s members, agents, employees, successors or assigns, from all liability whatsoever for personal injury, property damage or loss or wrongful death caused by its negligence.

I understand that participating in the activities offered by or associated with Route 377 Go-Karts LLC exposes me to many inherent risks, dangers and hazards. By engaging in any activities offered by or associated with Route 377 Go-Karts LLC, I freely accept and fully assume all inherent dangers and hazards and the possibilities of serious bodily injury, paralysis, death and property damage or loss resulting there from. I hereby voluntarily assume all risk of loss, damage and injury, including death that may be sustained by me or any property of mine while at Route 377 Go-Karts LLC.

This release shall be binding upon my family, estate, heirs, or assigns. This release shall continue in effect each time I rent and operate a go-kart at Route 377 Go-Karts LLC. Route 377 Go-Karts LLC may utilize photographic, video or other images of myself for subsequent advertising and promotion purposes without any fee or consideration to myself.

In signing the foregoing Liability Release, I acknowledge and represent:

That i have read the forgoing Liability Release, I understand it, and sign it voluntarily;

  • That I am not pregnant;
  • That I have not consumed alcohol or drugs which may affect my ability to drive a go-kart in a safe manner;
  •  That I do not suffer from a heart condition, high blood pressure or other medical condition which may be aggravated by my operating a go-kart;
  • That I will stay seated in the go-kart until instructed by a track official to get out of the go-kart;
  • That I will obey al rules and regulations of Route 377 Go-Karts LLC;
  • That I will closely observe and follow the instructions of all facility personnel;
  • That I agree TO PAY FOR ANY AND ALL DAMAGES to the equipment, facilities and any other part or parts;
  • there of caused by me, negligently willfully or otherwise;
  • That this agreement is continuing and shall remain in effect every time I use this facility;
  • That if I am under 18, I have a parent or legal guardian, sign this form.
First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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