[ ] Check
[ ]Cash *All car numbers must be approved; the PAS reserves the right to reassign the number.
Driver $50 **All cars must pay $40.00 entry fee per race. (Money will be collected at pill pick)
2012 PASSCAR MEMBERSHIP
[ ] Super
Stocks [ ] Street Stocks
[ ] Factory Stocks
[ ] Modifieds [ ]
Sport Mods [ ]
4cyl [ ] General
ANY driver, crew, member, spectator or car may be banned from the facility for whatever reason and period the management desires.
consideration of PASSCAR and/or their designee granting to me a license to
participate in sanctioned events, and to complete for prize money, or
other remunerationís, or to enjoy participation in scheduled sporting
events, I hereby grant to said PASSCAR, et al. and/or their designee:
All fees, salaries or other remuneration, including residuals
derived from any movie items, television, radio, advertising or other
entertainment media derived from my activities as a participant in any
PASSCAR sanctioned event.
The exclusive right to publish, sell or use in any fashion,
photographs of me or my equipment, with remuneration or notice to me.
A complete and unconditional release on behalf of myself and heirs
for any injuries sustained by me while participating in any sanctioned
event, or any damage to my property sustained while participating in any
a condition under which PASSCAR agrees to issue me a license to
participate in sanctioned events, I affirm the following representations:
My participation in any sanctioned event shall be on a voluntary
basis, in which event I shall be acting solely for myself as an
I will not act as an agent, servant of employee of PASSCAR or any
other person or organization if I participate in any event.
If, as a result of my voluntary participation in any sanctioned
event, I win any prize money ore receive other remunerationís, I do so
as an independent contractor, and will maintain all necessary financial
records and make all necessary tax returns.
As a voluntary participant in any sanctioned event, acting solely
on my behalf as an independent contractor, I recognize the fact that
PASSCAR does not provide workersí compensation insurance, unemployment
insurance, unemployment disability insurance, federal old-age survivors
insurance, state or federal taxes, or any other insurance.
As a voluntary participant in any sanctioned event, I fully
recognize the possibility of injury to my person and damage to my
property, and I freely assume this risk as a participant in any sanctioned
I hold PASSCAR and its affiliates harmless in the event of such injury to
my person or damage to my property.
I have read and understand this application for a participantís
I fully understand the application contains a general release to
all persons in any way connected with a sanctioned event, for any personal
injuries I sustain or any damage to my property.
am 18 years of age or older or have filed with PASSCAR a Minorís Release
Form approved by my parents or guardian.
|I HAVE READ AND FULLY UNDERSTAND THIS WAIVER AND RELEASE OF LIABILITY AND WAIVER OF INDEMNITY AND I KNOW AND UNDERSTAND THAT MY SIGNATURE ON THIS FORM RELEASES PASSCAR, TOGETHER WITH ITS OFFICERS, DIRECTORS, OFFICIALS, REPRESENTATIVES, AGENTS AND AFFILIATES FROM ANY AND ALL LIABILITY, INCLUDING NEGLIGENCE, AND I FREELY AND WILLINGLY CONSENT TO THIS WAIVER AND RELEASE OF LIABILITY AND WAIVER OF INDEMNITY AGREEMENT.|
Perris Auto Speedway, 18700 Lake Perris
Drive, Perris, CA 92571,
Phone: (951) 940-0134, Fax: (951)