EPHRATA RACEWAY PARK LICENSE AGREEMENT
Please type or print.  All blanks must be completed.  This form must be completed prior to first race.
Driver and car $50.00 - - Make checks payable to: Ephrata Raceway Park, P.O. Box 145, Ephrata, WA 98823

Driver’s Name ________________________________________________________________________________
Payee’s Address ___________________________________________ Phone Number _____________________
Emergency Name & Phone__________________________________________ email______________________
Class or Classes____________________________________________ Car Number(s) _____________________
Payee’s Social Security No. or Federal ID No.(Mandatory)__________________________________________
Age___________ Date of Birth____________ Under 18 - Annual Waiver must be completed and on file, signed by both parents. A parent or "handler" over 21 must accompany youth when in the Pits.
Health Ins. Co._________________________ Policy No._______________________________________________
Family: Spouse________________________ Parent if under 18_________________________________________

I do agree by signing this Ephrata Raceway Park License Agreement, that I will abide by all the rules and regulations set forth by Ephrata RacewayPark but not limited to the following:

Independent Contractor: I am an independent contractor assuming all responsibility for money received as a result of my activities including but not limited to income tax, FICA, Workman's Comp. and withholding taxes. I am not an employee or agent of Ephrata Raceway Park.
Rules
: I have or will have familiarized myself with all Ephrata Raceway Park rules and regulations now and hereinafter promulgated, which include car specifications and safety rules.
Spokesperson: I agree that I shall be the sole spokesperson for myself, the car owner, and the crew in all matters pertaining to compliance with the rules and regulations and I agree and understand that I am responsible for the conduct of said individuals.
Inspections: I agree and understand that by submitting my race car for various technical and safety inspections, I certify that the race car meets all rules and regulations for participation in Ephrata Raceway Park events, and I understand that the burden of proof will rest upon me to show that I am in compliance with all of the Ephrata Raceway Park rules and regulations, and I understand violation of various rules can result in a fine, suspension and loss of all track points.
Decisions: I agree that all decisions of Ephrata RacewayPark race officials or track officials regarding the interpretation and application of the Ephrata RacewayPark rules, and the scoring of positions, shall be non-litigable.  I further covenant and agree that I will not initiate any type of legal action against Ephrata Raceway Park or the Promoter, to challenge such decision, seek monetary damages, to seek injunctive relief any other kind of legal remedy.  I understand that if I pursue action, which violates this provision, then expressly agree to reimburse Ephrata Raceway Park or Promoters for all of it’s attorney’s fees and cost in defending against such legal action.
Safety: I understand that there is no express or implied warranty of safety resulting from publication or compliance with the rules of Ephrata Raceway Park, and that they are intended as a guide for the conduct of the sport and are in no way a guarantee against injury or death to participants, spectators and others.
Breach & Damage: In the event the undersigned breaches this agreement, he/she shall be liable for actual and liquidated damages sustained by Ephrata Raceway Park.
Ownership: As owner of a registred car, I certify I have marketable title to the competition vehicle, free and clear from liens and will deliver title to said vehicle or any part thereof if claimed pursuant to the rules.
Advertising Releases: The undersigned consents to the use of his/her name, pictures of him/herself and his/her car for publicity, advertising and endorsements both before and after the events, and relinquished any rights to photos taken in connection with events and consents to the publication or sale of such photos as Ephrata Raceway Park desires.
Ability to Perform: I certify I am physically able to compete and I am not a danger to myself or to others.
Disputes:
Any controversy or claim arising out of or relating to this agreement, including any alleged breach, shall be settled in accordance with the rules of Ephrata Raceway Park. The undersigned agrees to accept the decision as final without appeal.
Age:
I certify that at the time of signing this application, I am in fact at least fourteen (14) years of age.

I have read and fully understand this agreement. I agree to abide by all terms of this agreement and the rules of Ephrata Raceway Park.

Competitor’s Signature________________________________________ Date___________
Parent or Guardians signature if under 18_____________________________________
Emergency Name and phone__________________________________________________
www.ephrataracewaypark.com