2012 SACCC Open Car Show Registration Form

* * * * * * * * * * * Registration using this form (Pre-Registration) accepted until June 1, 2012 only. * * * * * * * * * * *

All items marked with an asterisk (*) are required.

Contact Details

1. * Name:
2. * Email address:
3. Telephone:

Vehicle Information

1. * Vehicle Year:
2. * Vehicle Make, Model

Delivery Address

1. * Address 1:
2. Address 2:
3. * City:
4. * State:
5. * Zip code:

HOLD HARMLESS AGREEMENT

1. I hereby agree to abide by all of the directions and decisions of the Spokane Area Classic Chevy Club. I hereby agree to indemnify, hold harmless and defend, the City Millwood, Washington, Millwood Parks Department, Spokane Area Classic Chevy Club, their respective members, officers, directors, agents, and employees from and against any and all liabilities, damages, actions, costs, losses, claims and expenses (including attorneys fees), on account of personal injury, death or damage to or loss of property or profits arising out of or resulting in whole or in part from any act, ommission, negligence, fault or violation of law or ordinence by me or my agents, sub-contractors, invitees or any other person entering the event and/or event area with my implied or express permission.
   In CONSIDERATION of the acceptance of the application for entry into the activities listed on the application form above this agreement and the rules and regulations that accompanied it, I hereby WAIVE, RELEASE, and DISCHARGE any and all claims for the damages for death, personal injury, or property damage which I may have, or which may hereafter accrue to me as a result of my participation in the said activities. This release is intended to discharge, in advance, the City of Millwood, Millwood Parks Department, Spokane Area Classic Chevy Club, its officers, agents, and employees from and against any and all liability arising out of or connected with my participation in the said activities, even though that liability may arise out of NEGLIGENCE or CARELESSNESS, on the part of the persons or entities mentioned above
   I HAVE READ THE DESCRIPTION OF THE ACTIVITY FOR WHICH I HAVE APPLIED, AND I AM AWARE THAT THESE ACTIVITIES SUBJECT ME TO PHYSICAL RISKS AND DANGERS. NEVERTHELESS, I VOLUNTARILY AGREE TO ASSUME ANY AND ALL RISKS OF INJURY OR DEATH, AND TO RELEASE, DISCHARGE, AND HOLD HARMLESS ALL OF THE ENTITIES OR PERSONS MENTIONED ABOVE WHO, THROUGH NEGLIGENCE OR CARELESSNESS, MIGHT OTHERWISE BE LIABLE TO ME, OR MY HEIRS, PERSONAL REPRESENTATIVES, NEXT OF KIN, SPOUSE OR ASSIGNS. It is understood and agreed that this waiver, release, and assumption of risk is to be binding on my HEIRS, PERSONAL REPRESENTATIVES, NEXT OF KIN, SPOUSE and ASSIGNS. I have carefully READ this Agreement and fully UNDERSTAND its content.
   I hereby give the Spokane Area Classic Chevy Club permission to use photographs and/or likenesses of my car without limitation and without compensation to me.
2. * I/we have read the above agreement and agree to its terms
* I/we agree to pay the registration fee of $10.00 upon arrival at the show.