PERSONAL MEDIA RELEASE |
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919-776-1781 |
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I hereby consent to and authorize the use by the above named party ("Track") or | ||||||||
anyone authorized by Track of any and all electronic recordings and/or photographic | ||||||||
images of me or my truck, and any reproduction of them, with or without cropping, | ||||||||
with or without juxtaposition or backgrounds of statements or images or both, and | ||||||||
with or without other modifications of alterations, for any purpose whatsoever, | ||||||||
including (but not by way of limitation) the sale, publication, display, broadcast and | ||||||||
exhibition thereof in promotion, entertainment, advertising or trade, with no financial | ||||||||
Compensation. I also consent to the use of my name in the connection with the | ||||||||
aforesaid videotape, but such use shall be limited to identifying me as the subject | ||||||||
Thereof. |
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I agree the videotape, photographs, and images in any other form thereof |
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constitutes the sole property of the Track with full right of disposition in any manner | ||||||||
Whatsoever. |
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As the Track proposes to act on this consent forthwith, I hereby declare it to be | ||||||||
irrevocable; and I hereby release and discharge the Track and all third parties in | ||||||||
reliance on Tracks authorization from any and all claims whatsoever in connection | ||||||||
with the use of such videotapes, photographs, and images in any other form and | ||||||||
my name and the reproduction thereof as aforesaid. |
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______________________________________________Date___________, 2010 |
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Printed Name of Subject
_________________________________________________________ |
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Signature of Subject |
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If Subject is less than 18 years of age, the following should be completed. |
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______________________________________________ |
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Signature of Parent/Guardian |
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PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
In consideration of the services of Darryl & Deborah Jones, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "D&DJ"), I hereby agree to release, indemnify, and discharge D&DJ, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that driving a 4 wheeler in a mudpit entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: acts of other participants; contact with plants or animals; my own physical condition, or my own acts or omissions; condition of roads, trails, waterways or terrain and accidents connected with their use; consumption of food or drink; riding on uneven terrain; loss of control; collision with other vehicles, participants, trees, rocks and other manmade or natural obstacles; falls from the vehicle; exposure to the elements, extreme temperatures, inclement weather; mechanical and/or equipment problems; and unavailability of immediate medical attention in case of injury.
Furthermore, D&DJ employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.
2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless D&DJ from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of D&DJ's equipment or facilities, including any such claims which allege negligent acts or omissions of D&DJ.
4. Should D&DJ or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
6. In the event that I file a lawsuit against D&DJ, I agree to do so solely in the state of
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against D&DJ on the basis of any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Signature of Participant ______________________________ Print Name _____________________________________
Address________________________________City__________State_____Zip________
Phone Date ____________,2
PARENT'S OR GUARDIAN'S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)In consideration of ______________________________________________________________________(print minor's name) (print minor's name) ("Minor") being permitted by D&DJ to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless D&DJ from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.