APPLICATION FOR METROPOLITAN SPORTS COMMITTEE CARD

Name


Parents Name (minors only)


Date of Birth

         Age

Street Address1


Street Address2


City


State

         Zip Code

Telephone

  (include area code)

Email Address

  (if applicable)

AMA#

  (if applicable)

Club

(if applicable)

   I am a NEW applicant                 I am a CURRENT (or PAST member) of MSC
Please enter your old MSC riding number if applicable:

Preference of riding #


Select one of the following that best reflects your present MSC Status:

PeeWee      Jr Mini       Senior Mini      Novice      Amateur      Expert 

                    Quad Expert       Quad Amateur    Quad Novice   Women

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IF ONLY THIS PAGE PRINTED YOUR PRINTER IS NOT WORKING PROPERLY

MSC Application continued ....

In consideration of being granted an MSC card and in consideration of being permitted to enter competition events of the Metropolitan Sports committee herein known as MSC, for myself, my heirs, personal representatives and assigns, herby release, discharge, and agree to hold harmless and indemnify the MSC, promoters presenting these events, the owners and lessees of premises on which events take place, the participants in the events, the owners, sponsors and manufacturers of all racing equipment upon the premises, and the officers, directors, officials, representatives, agents and employees of all of them, of and from all liability, loss, claims, demands and possible causes of action that may otherwise accrue from any loss, damage or injury (including death) to my person or property, in any way resulting from, or arising in connection with, or related to any event, and whether arising while engaged in competition or in practice or preparation therefore, or while upon entering or departing from said premises, from any cause whatsoever including without limitation the failure of anyone to enforce rules and regulations, failure to make inspections, or the negligence of other persons.  I know the risk and danger to myself and property while upon said premises or while participating or assisting in the event, and I do so voluntarily and in reliance, not upon the property, equipment, facilities and existing conditions furnished by others, but upon my own judgement and ability, and I thereby assume all risk for loss, damage or injury (including death) to myself and my property from any cause whatsoever and whether or not attributable to the negligence of others.

MEDICAL INSURANCE IS THE RESPONSIBILITY OF EACH RIDER

Parents or guardian of any rider under the age of eighteen may withdraw their permission signed at the bottom of this form at any time upon returning to the MSC by return registered mail, the MSC card issued to said minor and upon notification of   the withdrawal of such permission.  I understand that an MSC card is subject to MSC rules for competition.

Have your read this application?       (please type "YES" or "NO")

Now please PRINT this entire form AFTER you "TYPED IN" all of the above information on your computer.  Now remove the document from your printer and sign in ink below:

Rider Signature:   ------------------------------------------------------------      Date: ---------------------------------

NOTICE, IF UNDER 18 YEARS OF AGE, this application must bear the notarized signature of parent or guardian which shall acknowledge a waiver and release of any and all claims such parent or guardian may have.

Parent/Guardian Signature:   ----------------------------------------------------------------------------     

Subscribed and Sworn to before me this --------------------  day of --------------------------,    ---------------

Notary Public: -------------------------------------------------------------------------------------------------------------- 

Copyright © 2011 Metropolitan Sports Committee Family Motocross

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 INSTRUCTIONS:

#1. Enclose the appropriate fee.  Do not send cash. The fee must be sent in the form of a money order or certified check.  No personal checks please.
$25.00 for a seasonal membership Postmarked Before March 1st.
$35.00 for a seasonal membership Postmarked After March 1st.

#2. You must  prove your age by sending copy of your driver's license or birth certificate.  And if you are under 18 years of age the application must be notarized.

#3.  Mail the signed form (BOTH PAGES THAT YOU SEE ABOVE !!!!)
                 and your certified check or money order to =======>

Metropolitan Sports Committee
c/o Amy Rutledge,
28 Private Lane
Olivebridge, NY 12461

#5.  Further questions?  Contact Amy Rutledge at 845-657-7259