Stuntin insurance waiver??

[Brandon L]

Liability Release Form

I,______(NAME)________________here by agree to the following rules set forth by the property

owner,____________(NAME)_______________of said property, _____(ADDRESS)_____________,

__(CITY)____________, __(STATE)_.


I agree that I have permission to operate my motorcycle, a __(MAKE/MODEL)____, VIN number

___________________, on the above stated property. Under no circumstances is the owner of said

property responsible or liable for any damages, personal or property, to my motorcycle or myself. I am

fully and completely aware of the dangers involved in operating my vehicle. This includes, but is not

limited to: death, dismemberment, permanent or temporary impairment, paralysis, loss of limb(s), etc.

Under no circumstances do I have the legal right to pursue the property owner for compensation of

damages occurring to my motorcycle or myself. I also agree that any damage caused by my occupancy or

temporary use of the property is to be reported immediately to the property owner. It is solely my

responsibility to repair/correct any alterations I cause to the property. In the event the property owner

cannot be reached the caretaker,____________________, will be notified immediately. It is my responsibility to

provide, and wear, the appropriate safety gear while operating my motorcycle on the property. Public

access to the property will be restricted and controlled by the use of caution tape and or brightly colored

cones, which shall be removed before leaving the property. This is to prevent unauthorized access and deter

spectators. This is a legal binding agreement between the property owner and myself. I will not try and

alter, forge or destroy this agreement, which may be punishable by law, because I am entering into it

completely and willingly. Any violation of this agreement will result in my loss of privileges to access the

above referenced property, and legal action may be pursed by the owner. Any alterations to this agreement

must be made in writing and signed by both the motorcycle operator and the property owner. If the property

owner is unavailable the caretaker,______________________, shall serve as the needed signature. There will be no

exceptions.


Motorcycle Operator: ________________________ DOB: ____________
SIGNATURE
Contact phone #1: ___________________ Contact phone #2: ____________________

Emergency Contact: __________________________ Phone: _________________

Property Owner/Caretaker: ________________________ Date: ____________
SIGNATURE