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I, THE UNDERSIGNED, BEING OF LEGAL AGE AND SOUND MIND AND NOT BEING UNER THE INFLUENCE OF ALCOHOL, DRUGS, OR OTHER INTOXICANTS, HAVE READ AND UNDERSTAND THE FOREGOING AGREEMENT AND RELEASE.

OWNER ACKNOWLEDGES RECEIPT OF A COPY OF THIS AGREEMENT.

Please print:

Owner:

Date:

_______________________________

___________

Address:

______________________________________________

City:

____________________

State:

________

Zip:____________

Home phone:

Cell:

___________________ __________________

Work phone:

___________________ Work hours:______________

Other Emergency number:

________________________________

Email:

________________________________________________

Signature of Owner:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date:

__________

Signature of Parent or Guardian if owner is a minor:

Date:

______________________________________

___________

Printed name of parent or guardian:

______________________________________________________

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