PRE-ENTRY FORM

1. Complete this form online.
2. Print the completed form and sign the Waiver of Indemnification Release.
3. Complete Payment on the next page or mail Check or Money Order with this form to address below.
4. Remember to bring signed form to the race.
Iowa ATV Hare Scramble Series, L.C.
3472 S23 HWY
Carlisle, IA  50047
For more information, call 515-989-3052

ALL TIMES ARE APPROXIMATE
Please check appropriate class below
Event:
Date:
AMA/ATVA#:
ATV Brand:
ATV#:
Name:
Address:
City:
State:
Zip:
Phone:
DOB:
Age:
E-Mail:
 (Please use Paypal e-mail address)
Pro Class SSN: (To be filled out @ race)  ____________________________

 

EVENT #1 = 50 / 70 / 90cc
8:30 - 9:00 am (50) / 9:00 - 9:45 am (70/90)
Entry Fee $20
EVENT #2 = C, Util, Women, Jr, Stock
10:00 am - 12:00 pm
Entry Fee $30
EVENT #3 = AA, A, B, +30, +40
1:00 - 3:00 pm
Entry Fee (AA) $50 / (A) $40 / (B,+30,+40) $30

Select your class below:







50cc Production
     

WAIVER OF INDEMNIFICATION AND RELEASE
I, the undersigned, do hereby for myself, my heirs, executors, and assigns, release, remise and forever discharge and agree to indemnify and hold harmless individuals, officers, agents, sponsors, sanctioning bodies, servants, employees of and from every claim, demand, action or right of action of whatsoever kind or nature and any cost, lost or expense in connection therewith arising from or any reason of, or on the occasion of any use by the Iowa ATV Hare Scramble Series, L.C., referred to as IAHSS, L.C., it's course or related facilities, incuding any claims or demans for injury to, or death of any person or damage to, or destruction of, any property resulting from or claim to result from or arise out of accident or for occurrence during or in connection with said use including specifically such as may arise out of or be claimed to arise out of negligence on the part of said IAHSS, L.C., it's individuals, officers, agents, sponsors, co-sponsors, sanctioning bodies, servants and employees.
This Waiver of Indemnification and Release is given and this agreement is made in consideration of and as a consideration of and as condition to permitting the undersigned to use course of circuit or facilities or act as an official or spectator or participant or to be present in any other capacity whatsoever at said event. I have read the foregoing Waiver of Indemnification and Release and fully understand that no officer or agent or employee of the IAHSS, L.C. is authorized to vary the terms or provision of this instrument or to make representations contrary to the provisions hereof.
I hereby grant IAHSS, L.C., it's media licensees and assigns, permission to use and publish, in any media now or hereafter known, my name, likeness and voice as captured at an IAHSS, L.C. event, for purposes of promotion, art and commerce.
It is further understood and agree that in the event I am injured from whatsoever cause during the event covered by the application, I herewith consent and authorize first aid and ambulance service as provided by sponsoring club, organization or landowner, and further hold all parties harmless from any consequences of said aid.
Under the rules of IAHSS, L.C., I hereby agree to conform and comply with the rules governing this contest. I declare that the rider listed on this entry application possesses the standards of competence necessary and is physically fit for an event of this type for which this entry relates and the vehicle entered is roadworthy and suitable for this event.
This is a dangerous sport.  By signing below, you certify that you have read and understand this Waiver of Indemnification and Release.

Signature ___________________________________________________________  Date _____________________
(if under 18 years of age, Parent must sign)
1st . . .

then. . . .