Durham Eastenders British Car Club (DEBCC)

Release Form

□Member

Name:_______________________________________________________________________

Address:_____________________________________________________________________

City:___________________________ Ontario Postal: _________________________________

Telephone:______________________ Cell:_____________ Email:_______________________

DEBCC. #______________________ Expiry Date:__________________

Driver’s License #_________________ Plate (1)________________Model/Year____________

Plate (2)________________Model/Year____________

Plate (3)________________Model/Year____________

I have read the DEBCC Constitution & By Laws and agree to abide by them if I am accepted as a member. I have read, understand and agree to the usual release required by DEBCC regarding public liability for any property damage or injury incurred during Club activities and agree not to sue DEBCC and/or the respective officers, directors, employees and agents (hereinafter, the “RELEASED PARTIES”) for any injury or damage sustained.

□Member

□Non-Member

Signature______________________________ Officer Approval:____________________

Date: __________________________________ Date: _____________________________

PLEASE READ THIS RELEASE BEFORE SIGNING

The undersigned (on my own behalf, and that of my heirs, personal representatives, successors and assigns), for and in consideration of the opportunity to participate in a “Ride”, “Rally”, “Field Meet” or “Activity” (hereinafter, “EVENT(S)” sponsored and or conducted by DEBCC and the respective officers, directors, employees and agents (hereinafter, the “RELEASED PARTIES”) releases and holds harmless the “RELEASED PARTIES” from any and all claims and demands, rights, and causes of action of any kind whatsoever which I now have or later may have against the “RELEASED PARTIES” if any resulting from, arising out of, or in connection with my participation in any said EVENTS(S). This release extends to any and all claims I have or may have against the “RELEASED PARTIES” whether or not such claims result from negligence (except willful neglect) on the part of any or all of the “RELEASED PARTIES” with respect to the EVENT(S) or with the respect to the conditions, qualifications, instructions, rules or procedures under which the EVENT(S) are conducted or from any other causes. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE ANY OR ALL OF THE “RELEASED PARTIES” FOR ANY INJURY RESULTING TO MYSELF OR MY PROPERTY ARISING FROM, OR IN CONNECTION WITH SAID EVENT(S).

I further certify that I have a valid driver’s license, vehicle insurance, a current license plate tag/sticker and my vehicle conforms to Ontario Ministry of Transport requirements for that vehicle.

I am voluntarily participating in the EVENTS(S) and I expressly agree to assume the entire risk of any accidents or personal injury, including death, which I might sustain to my person and property as a result of my participation in EVENT(S), whether or not such risk resulting from negligence (except willful neglect) on the part of any or all of the “RELEASED PARTIES”.

By signing this Release, I certify that I have read this Release and fully understand it and that I am not relying on any statements or representations made by the “RELEASED PARTIES”.

DRIVER PASSENGER(s)

Signature_________________________ Signature________________________

Print Name________________________ Print Name_______________________

Address__________________________ Address________________________

City/Postal________________________ City/Postal_______________________