Liability Form - Chrome Shop Mafia

Date*

This Release and Waiver of Liability (the “Release”) executed on this date

Full Name*

on behalf of

Consent*

, (the “Participant”), releases Four State Trucks, Inc., its affiliates, its directors, officers, employees, and agents from all liabilities assumed by Participants involvement and participation in any and all activities related to the Guilty By Association Truck Show (the “Event”). I, the Participant, do hereby consent to participation in all actions and activities of the Event including but not limited to: * Demolition Derby * Monster Truck Events * Truck & Tractor Pull * Motorcycle & Four-Wheeler Stunt Show * Fireworks Display * Big Rig Convoy * Concert Event & Light Show

The Participant is responsible for the Participant’s own insurance coverage in the event of personal injury or illness as a result of participation in activities of the Nonprofit. 1. Waiver and Release: I, the Participant, Release and forever discharge and hold harmless Four State International Trucks, Inc. and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the activities as a participant in the Event, including claims arising out of negligence. I understand and acknowledge that this Release Discharges Four State International Trucks, Inc. from any liability or claim that may arise with respect to bodily injury, personal injury, illness, death, or property damage that may result from the Participant’s involvement in the Event’s activities.
2. Insurance: I, the Participant, affirm that the Participant is covered by primary medical insurance and understand that the Participant is responsible for its own medical bills if injury occurs. Further, I understand that Four State International Trucks, Inc. does not assume any responsibility for or obligation to provide the Participant with financial or other assistance, including but not limited to medical, health or disability benefits or insurance of any nature in the event of the Participant’s injury, illness, death, or damage to his or her property. I expressly waive any such claim for compensation or liability on the part of Four State International Trucks, Inc. beyond what may be offered freely by Four State International Trucks, Inc. in the event of such injury or medical expenses incurred by the Participant.
3. Assumption Of Risk: I, the Participant, understand that the activities of the Event and which the Participant is involved in may include activities that are inherently dangerous to the Participant. I hereby expressly assume the risk of injury or harm of the Participant from these activities and Release Four State International Trucks, Inc. from all liability for injury, illness, death, or property damage resulting from these activities.
4. Photographic Release: I, the Participant, grant and convey to Four State International, Inc. all right, title, and interest in any and all photographs, images, video or audio recordings of the Participant or his or her likeness or voice made by Four State International Trucks, Inc. in connection with the Participant’s involvement in the Event, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
Medical Treatment: I, the Participant, hereby Release and forever discharge Nonprofit from any claim whatsoever which arises or may hereafter arise an account of any first-aid treatment or other medical services rendered in connection with an emergency during the Participant’s activity with Four State International Trucks, Inc. We give our consent for Four State International Trucks, Inc. to provide, administer, or obtain medical treatment for the Participant.
6. Other: I, the Participant, expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Missouri and that this Release shall be governed by and interpreted in accordance with the laws of the State of Missouri. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.
By signing below, I, Participant, express my understanding and intent to enter into this Release and Waiver of Liability knowingly and voluntarily.
I understand by typing my name below my will be used as a e-signature, My signature will only be used for the items on the liablity form, they will not be shared with third paries or used for any signups for opt ins. The email below is only to be used to send me a copy of the forms I have signed.

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