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Vehicle Waiver

 I agree that by signing this waiver I assume all liability for any vehicle or engine damage that could occur regardless of how it occurs.

 I agree to indemnify and save harmless:

·       The Speed Shop

·        Andy’s Auto Centre 2011 Ltd.

·       Andy’s Auto Courtenay Ltd.

·        All employees of the above listed companies.

·       All proprietors of the above listed companies.


·       I have read and performed all necessary work to comply with the pre-dyno checklist.

·       I agree to have my vehicle put on a hoist for a safety inspection, to ensure it’s mechanically sound and that all fluids levels are adequate.

·       It’s strongly recommended that the oil and filter be changed.

·       The fuel tank should be full with the fuel that you intend to use it with.

·       All circle track cars must not have any stagger in the rear tires.


First Vehicles legal owners' Name

First Name*

Middle Name

Last Name*

Phone*
First Vehicles legal owners' Age Acknowledgment*
First Vehicles legal owners' Date of Birth*
I certify that I am 18 years of age or older
First Vehicles legal owners' Signature*
Second Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Second Vehicles legal owners' Date of Birth*
Third Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Third Vehicles legal owners' Date of Birth*
Fourth Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Fourth Vehicles legal owners' Date of Birth*
Fifth Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Fifth Vehicles legal owners' Date of Birth*
Sixth Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Sixth Vehicles legal owners' Date of Birth*
Seventh Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Seventh Vehicles legal owners' Date of Birth*
Eighth Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Eighth Vehicles legal owners' Date of Birth*
Ninth Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Ninth Vehicles legal owners' Date of Birth*
Tenth Vehicles legal owners' Name

First Name*

Middle Name

Last Name*
Tenth Vehicles legal owners' Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Vehicle Description:
Click to customize checkboxes
I consent to to have photos/Video of my vehicle used for promotional purposes
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*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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