Please complete this event registration and release form to participate in the Apex Assassins Motorcycle Track Day event at

Chuckwalla Valley Raceway


Friday, September 23rd, 2022

As consideration for being allowed to participate in the event(s) described below I agree:

I acknowledge that riding a motorcycle is a dangerous activity and carries with it the potential for death, serious injury and property loss. These risks are caused by many factors, including but not limited to, roadway conditions, other riders, track conditions, weather conditions, mechanical conditions of my vehicle, mechanical condition of other riders' vehicles, my own training, experience and actions, the training, experience and actions of other riders and spectators, and the actions of other people. These hazards exist on the track, while entering and exiting the track and in the pits. I hereby assume all of the risks of participating, viewing and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities organizing or conducting this event and hereby release them of all possible liability. I certify I am at least 18 years old.

I agree that Apex Assassins, LLC, has not dictated my actions, and that my participation in this event is voluntary. Apex Assassins, LLC, has provided me with reasonable and adequate instruction for using the track and understanding the signals and rules of the track, and has answered any and all questions I have prior to my use of the track. While the track configuration, direction and time for using the track were selected for me, I am responsible for the actions I take while I am on the track, the speed I ride and all other risks while I am riding to, from and on the track. The speed I ride, the lines I chose, the time I spend on the track and when I decide to get on and off the track are all up to me, and there is no time requirement imposed upon me in connection with my ride today. I promise not to sue and agree to pay all court costs and all attorney fees that result from my action, civil or otherwise, or carelessness on the part of the persons or entities organizing or conducting this event and hereby release them of all possible liability.

I certify that I am physically fit with no known physical or mental impairment and have prepared for participation in the event. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers of the event in which I may participate and that it will govern my actions and responsibilities at said events. I certify that I am not under the influence of any narcotic, alcohol or other substance that may impair my understanding or judgment and that I will not at any time during the event operate my motorcycle or any vehicle under the influence of any narcotic, alcohol or drug. I certify that I have fully adequate insurance to cover all medical claims, the motorcycle and any other equipment and any damage or liability I may ultimately be found responsible for during any point from try arrival at the event to my departure from the event. I further certify that I am competent to operate a motorcycle in a safe manner and that I have obtained all the training and experience necessary to operate my vehicle on the track.

I certify that I have inspected the mechanical condition of my vehicle prior to the time I arrived at the track and that I will fully and reasonably inspect and maintain the mechanical condition of my vehicle throughout my participation in the event. My vehicle is safe, free from mechanical defect, free of any fluid leaks and loose parts, I have inspected the tires, and all drain plus, fillers, caps and fasteners to insure that no part will fall off, fail or leak during the event. I also certify that I have caused my vehicle to be inspected by a qualified motorcycle mechanic prior to my participation in the event and that all necessary repairs to render my vehicle safe for track operation were made by said mechanic prior to my participation in this event. While Apex Assassins, LLC, will conduct a technical inspection, it is impossible for Apex Assassins, LLC, to identify every problem or defect on my vehicle in a technical inspection and I am in no way relying on Apex Assassins, LLC, to certify that my vehicle, nor any other participants' vehicle, is safe for the track or will not fail and cause injury, death or property damage. I agree that I am solely responsible for any injury, death or property damage that is caused by the mechanical failure or leakage of my vehicle, or the mechanical failure or leakage of any other participants' vehicle.

I understand that Apex Assassins, LLC, events will occur as scheduled, regardless of weather, rain or shine. It is my sole decision whether to participate in the event should the weather vary and should the temperature become excessively hot or cold, or if it should rain or if any other inclement weather should present itself. I understand that I am not required to participate should the weather vary or change, and that weather changes, such as excessive heat or cold, rain or other weather conditions may create additional hazards and risks of injury, death and property damage that I solely am responsible for. I understand I need to adjust my hydration and exertion depending on the temperature, and adjust my riding for changes in weather and track conditions. It is my responsibility to make these changes and I am not relying on Apex Assassins, LLC, to make these decisions for me.

I Agree

In consideration of my being permitted to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me during the event or during my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: ride organizers, and owners of the organizers, employees of the organizers and other agents of the organizers, sponsors, representatives, agents, volunteers and (B) indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of any of my actions during this event. Accordingly, I do hereby release and discharge all ride organizers, owners of the organizers, employees of the organizers and other agents of the organizers, directors, employees, ride organizers, sponsors, representatives and agents, and their officers, agents and its employees from all claims, demands, and causes of action of every kind whatsoever for any death, damages and /or injuries which may result from my participation in this event. This shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and or illnesses during the event. I agree to pay for any and all costs related to medical response, treatment and transport on my behalf.

I understand Apex Assassins, LLC, strongly recommends the use of appropriate safety gear including a helmet, jacket, gloves, leathers and boots, but the decision as to what safety gear to wear is mine alone, so long as I am in compliance with the rules of the track we are riding on and Apex Assassins, LLC, rules. I certify I will wear the personal protective equipment while operating my motorcycle at this event and that my motorcycle and all required personal protective equipment are in safe operational condition. I agree to abide by the directions/rules given by the organizers of this event and understand that my privilege to ride may be removed without refund if I am in violation of the rules set forth or acting/performing in an unsafe manner, or any manner disruptive to the operation of the event(s).

I hereby release the organizers, their owners, employees, and agents from any and all claims based upon or arising out of the use, reproduction, distribution, display, or performance of all or any part of the photographs or recording, or any derivative thereof, including any claim of invasion of privacy or right of publicity. I agree any photograph or video taken of me in this event may be subsequently used on Social Media or Websites of the organizers, their owners, employees and agents, including but not limited to Facebook.

I hereby certify that I have read all pages of this Waiver, Release and Assignment of Claims in its entirety. My signature below indicates that I fully understand it and agree to its contents.

First Rider's Name

First Name*

Last Name*

First Rider's Date of Birth*
First Rider's Signature*
Second Rider's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
Motorcycle Information

Motorcycle Year *

Motorcycle Make *

Motorcycle Model *
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*

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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