I HAVE DISCUSSED THE EVENT THAT I WISH TO PARTICIPATE IN WITH MY PARENTS OR LEGAL GUARDIANS AND THEY HAVE EXPLAINED TO ME THE POSSIBILITY OF MY BEING INJURED. I UNDERSTAND WHAT THEY HAVE EXPLAINED TO ME, AND I KNOW THAT I COULD BE INJURED, POSSIBLY SEVERE, OR EVEN WORSE.

I AM WILLING TO ASSUME THE RESPONSIBILITY OF THIS IN ORDER TO BE A PARTICIPANT IN THE EVENT THAT I WISH TO PARTICIPATE IN.

I ALSO AGREE THAT, AT ANY POINT, IF I FEEL ENDANGERED EITHER BY MY OWN ACTIONS OR THOSE OF OTHERS, THAT I AM FREE TO WITHDRAW FROM THE EVENT, AND WILL DO SO OF MY OWN FREE WILL.

I KNOW THAT I AM NOT GIVING UP ANY OF MY RIGHTS AND THAT IT IS OK FOR ME TO PARTICIPATE. I HAVE READ THE ABOVE ASSUMPTION OF RISKS. I FULLY UNDERSTAND WHAT IT MEANS, AND HAVE SIGNED IT VOLUNTARILY.

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MINOR'S SIGNATURE

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MINOR'S SIGNATURE

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MINOR'S PRINTED SIGNATURE

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FATHER'S SIGNATURE

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MOTHER'S SIGNATURE

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OR

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LEGAL GUARDIAN'S SIGNATURE

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DATE

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CLUB/PROMOTER NAME

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LOCATION AND DATE