Willpower Incorporated – Taking Care of Quartzsite

Print this form, read it, fill in the required information & mail it to Willpower Inc., Box 3035, Quartzsite, AZ 85359

Phone (928) 916-0657 for more information

3rd Annual Willpower Inc ATV & Off-Road Vehicle Parade

Saturday, February 9, 2008 -- Line up at 8 a.m. at the Fire Station on Tyson Road

Registration Form  + Waiver & Release

PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISK

In consideration of the services of Willpower Incorporated, their agents, owners, officers, volunteers, participants, employees and all other persons or entities acting in capacity on their behalf, I hereby agree to release and discharge Willpower Incorporated, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

   I acknowledge that certain known and unanticipated risks which could result in physical or emotional injury, paralysis, death or damage to myself, to property, or to third parties. I understand that such risks simply can not be eliminated without jeopardizing the essential qualities of the activity. The risks include among other things: Collision with other riders or objects along the trails, walls or other fixed objects; falling down; my own equipment failure or the failure of other’s equipment; my own or other’s negligence; objects or conditions on the surface that may cause me to fall; broken bones, sprains, head, neck and back injuries, abrasions and bruises.

   I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Willpower Incorporated from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Willpower Inc.’s equipment or facilities, including such claims which allege negligent acts or omissions.     

   Should Willpower Incorporated, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.  

   I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating. Or else, I agree to bear the costs of such injury or damage. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity. Or else, I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.  

   I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.

  By signing this document, I agree that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Willpower Incorporated on the basis of any claim from which I have released them herein.

I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound by its terms.

© 2008 Willpower Incorporated

page last updated:

Monday, January 7, 2008