The event medical doctor will complete and sign off on all information you provide below. Any fraudulent information on this form, or any attempt to misled officials, will have you removed and suspended from this event. Be honest in your answers.

MEDICAL CARE ACKNOWLEDGMENT

By participating in this event, I understand that If medical care and/or medical transport recommended by our event Physician is refused, I am accepting full insurance or personal payment liability/responsibility as I will not be covered under our secondary event insurance coverage. By signing this document and participating in our event, you release from liability all parties involved, including the promoter, venue, officials and others. My signature verifies that I agree to the aforementioned statement.