CAR SHOW

ENTRY AND RELEASE FORM

SPECIAL AWARDS
- CHIEF'S CHOICE
- PEOPLE'S CHOICE
- EXPLORE LOMPOC
- BEST OF SHOW
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Vehicle Information:
Year
Please enter a value between 1900 and 2019.
Make
Model
Exterior Color
Engine
Class #
Club Affiliation
In consideration of the acceptance of the right to participate; the undersigned hereby voluntarily releases, discharges, waives, and relinquishes any and all actions or courses of action for personal injury, property damage, or wrongful death occurring to himself arising as a result of engaging in, or receiving instructions in, said activity or any activities incidental thereto wherever or however the same may occur and for whatever periods that activities or instruction may continue, and the Undersigned does for himself,his heirs, executors, administrators,and assigns hereby release, waive,discharge and relinquish any action or course of action,aforesaid, which may hereafter arise for himself and for his estate, and agrees that under no circumstances will he or his heirs, executors,administration administrators,and assigns prosecute, present any claim for personal injury, property damage, or wrongful death against the City of Lompoc or any of its officers, agents, servants, or employees for any of said causes of action, whether the same shall arise by the negligence of said persons or otherwise. I/we are the parent(s)/guardian(s) of a minor. We hereby consent to said minor's participation in the above described City of Lompoc activity. We hereby agree to indemnify and hold harmless the City of Lompoc from any claim for injuries or damages that said minor may have against the City by reason of his participation in said activity.
Entrant's E-Signature
Date
Signature of Parent/Guardian
Date

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CAR SHOW

ENTRY AND RELEASE FORM

SPECIAL AWARDS

Vehicle Information:

Address

Phone Number

Email