STASIK FAMILY ATV

Ride form - Permission Form

Add your custom HTML here Permission, Assumption of Risk & Release Form

Parent/Guardian Permission, Assumption of Risk & Release

Property: 64 Skippack Creek Rd, Souderton, PA
Activity: Use of dirtbike/ATV track

Participant Name of Minor

Date of Birth

Address

Parent / Guardian Name

Relationship

Phone

Permissions & Consents Permission to Participate Assumption of Risk Release & Waiver of Liability Indemnification Rules / Safety Equipment Medical Treatment Consent Photo/Video Release

Signatures & Emergency Contact Parent/Guardian Printed Name Date Participant Printed Name (if able) Participant Date Emergency Contact (name & phone)

By submitting this form, you acknowledge you have read and understand the contents. This form is not legal advice — consider review by a Pennsylvania attorney.

STASIK FAMILY ATV

Parent/Guardian Permission, Assumption of Risk & Release

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