Liability Release Form (Page 2)

SIGNER STATEMENT OF AWARENESS

I/WE, THE UNDERSIGNED, HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT, WARNINGS, RELEASE AND ASSUMPTION OF RISK. I/WE FURTHER ATTEST THAT ALL FACTS RELATING TO THE APPLICANT'S PHYSICAL CONDITION, EXPERIENCE, AND AGE ARE TRUE AND ACCURATE.

_______________________________________________________________ ___________________
SIGNATURE OF RIDER DATE


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RIDER’S NAME (PRINT)

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ADDRESS

_______________________________________________________________

_______________________________________________________________
PHONE



SIGNATURE OF BOTH OF RIDER’S PARENTS / GUARDIANS REQUIRED IF MINOR LESS THAN 18 YEARS OLD:

___________________________________ _________________________________________
 

 ___________________
PARENT / GUARDIAN NAME (PRINT) SIGNATURE DATE


___________________________________ _________________________________________ ___________________
PARENT / GUARDIAN NAME (PRINT) SIGNATURE DATE


By my signature above, I certify that I am the legal guardian of Rider, and that I am legally entitled to execute this document on behalf of the Rider if a minor.

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