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San Antonio JEEP Exclusive
Waiver & Registration Form

Name:_______________________________________________________

Passengers:___________________________________________________

                  ___________________________________________________

                  ___________________________________________________

Address:_____________________________________________________

Phone:_______________________________________________________

Make/Model:__________________________________________________

Release & Waiver of Liability and Inemnity Agreement
to San Antonio JEEP Exclusive

In consideration of being permitted to participate in any event sponsored, promoted, or directed by JEEP EXCLUSIVE, the undersigned for himself, his personal representatives, heirs, and next of kin, HEREBY RELEASES the association, officers, directors, promoters, sponsors, and members of the association of all liability to the undersigned, his personal representatives, heirs, and next of kin for any loss or damage on account of injury to the undersigned whether caused by the negligent act or omission of Releasees or otherwise while the undersigned is for any purpose participating in such event. It is fully understood by each of the undersigned that there is some inherent risk associated with this event, including damage to vehicles.

IN ADDITION, the undersigned AGREES TO INDEMNIFY AND HOLD HARMLESS the Releasees from any loss, liability damage, or cost they incur due to such participation by the undersigned, whether caused by Releasees' negligence or otherwise and AGREES TO ASSUME FULL RESPONSIBILITY AND RISK for any bodily injury, death, or property damage from Releasees' negligence or otherwise while undersigned is participating in this event.

In signing this release, each of the undersigned hereby acknowledges and represents the following:

1. That he or she has read the foregoing Release and Waiver of Liability and Indemnity Agreement.

2. That he or she shall at all times, while riding in a vehicle participating in this event, wear their respective seat and shoulder belts, if available.

3. That the owner/driver certifies that he/she has inspected this vehicle and same is in good mechanical condition.

4. That the owner/driver has informed himself about the event and trail involved in the event, either by prior participation or by investigation into the event and trail.

WAIVER MUST BE SIGNED BY ALL PARTICIPANTS. (For a participant under the age of 18 years of age, both parents, the parent with legal custody, or the minor's legal guardian must sign this release form and write the word "minor" and age next to the minor's name).



Vehicle__________________________________________
License No./State__________________________________
Owner/Driver_____________________________________

Date
_________
_________
_________
Participant's Signature
_____________________________
_____________________________
_____________________________
Print Name
____________________________
____________________________
____________________________

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