Electrek Valley Release of Liability, Waiver of Claims, Assumption of Risks & Indemnity Agreement Parent/Legal Guardian

1.Release of Liability. The undersigned, on behalf of him/herself, his heirs, personal
representative, executor, administrator or assigns, as partial consideration for his use of the premises provided, does hereby release, acquit and discharge Brick City Moto Collective, LLC, dba Electrek Moto, dba Electrek Valley and each of their directors, officers, members, employees and agents, together with their successors, assigns, executors, administrators and personal representatives (sometimes referred to herein respectively and collectively as “Electrek Valley”) from any and all claims, demands, damages, costs, expenses, loss of services and causes of action, at law or in equity, arising out of or resulting from the undersigned’s use of or activity on any property or facility owned, operated, provided by, leased, or controlled by Electrek Valley (hereafter, the “Premises”), including but not limited to motorized cycles, ebikes, bicycles, electric motorcycles or recreational vehicle trail riding or racing, or any ancillary activities including but not limited to watching, assisting, or officiating such activities, regardless of whether such claim, demand, cost, expense, or cause of action results arises from property damage or personal injury, and regardless of fault of Electrek Valley. IT IS EXPRESSLY AGREED BY THE UNDERSIGNED THAT THIS RELEASE SHALL APPLY TO EACH AND EVERY USE OF THE PREMISES BY THE UNDERSIGNED.

2.Assumption of Risk/Dangerous Activity. The undersigned recognizes and acknowledges that track racing and riding are inherently dangerous activities often utilizing very rugged terrain by persons participating in such activities, or ancillary activities or present in the general area in which such activities are conducted is in danger of suffering serious bodily injury, personal injury and property injury. THE UNDERSIGNED IS AWARE THAT THE RACE SURFACE MY BE ROUGH OR UNEVEN AND THAT IT CONTAINS MANY HAZARDS. THE UNDERSTANDS THAT S/HE IS PARTICIPATING IN A DANGEROUS SPORT. THE UNDERSIGNED HEREBY ASSUMES THE RISK OF ALL SUCH INJURIES WHICH S/HE MAY SUSTAIN IN CONNECTION WITH HIS USE OF FACILITIES PROVIDED BY ELECTREK VALLEY.

3.Skills and Rules/Safety Equipment. The undersigned certifies that s/he has examined the premises s/he intends to use, is familiar with them and that he is capable and skilled in the use of equipment, if any, that s/he will operate on the premises. The undersigned acknowledges that s/he has read and is familiar with and also agrees to obey any rules of Electrek Valley that are posted, and any other rules, regulations and directions of Electrek Valley and other sponsor, any official and all state, local or national laws or government regulations regarding such activities. The undersigned further agrees to wear any safety equipment required by Electrek Valley.

4.Waiver. No officer, director, employee, agent servant or other representative of Electrek Valley, is authorized to vary the terms and provisions of this instrument or to make any oral or written representation contrary to any provisions hereto or otherwise in connection with the subject matter hereof.

5.No Warranties. The undersigned acknowledges that Electrek Valley, have made no warranty, express or implied, regarding the condition of the premises to be used by the undersigned or the physical or mental condition, competency or skills of any other person using the premises or officiating any event held upon the premises.

6.Indemnity Against Minor’s Claim. In the event that this agreement is signed on behalf of a minor by a parent or guardian, and the minor makes any claim upon Electrek Valley at a later time, the parents or guardian signing this release hereby agree to Indemnify and hold harmless, Electrek Valley from and against any and all loss, cost, damages or awards, including attorney’s fees, suffered by Electrek Valley.

7.Inspection and Acceptance of Premises. The undersigned certifies and agrees that he will carefully examine the premises prior to each use, and that his participation in any event or the use of said facilities will automatically indicate his acceptance of the conditions of the premises as being reasonable and safe for the purposes for which they are used, and that the facilities and premises are accepted in an “AS IS” condition without any reservation, limitation, or warranty.

8.Indemnity. I agree to indemnify, save and hold harmless, Electrek Valley from and against any injury, damage or costs caused by my acts or omissions, negligent or otherwise, including any costs and attorney’s fees incurred thereby, arising out of my use of the premises.

9.Partial Invalidity. It is understood and agreed that this release is intended and shall be read as to be as broad and inclusive as permitted by law; that if any portion of this release is held invalid, the remaining provisions shall be read in favor of Electrek Valley. The release shall be in effect for any and all events or use of said facilities on premises.

Please select who will be participating...
First Participant's Name

First Name*

Middle Name

Last Name*

First Participant's Date of Birth*
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Parent or Guardian's Email Address


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Emergency Contact

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Emergency Contact's Phone Number*

Insurance Carrier*

Insurance Policy Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*


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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