Local Race Registration Form 2023

MARK WHICH DIVISION YOU ARE PARTICIPATING IN:*

StockSuper StockMasters

Participant's Name*

Local Race City Organization

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Please enter a valid phone number.

School Grade*

Age*

Date of Birth*

Date

Parent/Guardian Email*

example@example.com

What year did you begin racing Soap Box Derby?*

How did you learn about Soap Box Derby racing?

Participant's Name*

Local Race City Organization*

Participant Signature*

Date*

Date

Parent/Guardian's Name*

Relationship to Participant*

Same address?

Yes

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Parent/Guardian's Name*

Participant's Name*

Local Race City Organization*

I, {parentguardiansName} (parent/guardian), hereby certify that my son/daughter/ward, {participantsName}, entrant in the official Soap Box Derby Local Race being held in Cincinnati, OH, has read the above statement completed by my son/daughter/ward and know the facts stated therein to be true. Further, I hereby grant permission for my son/daughter/ward to enter the official Soap Box Derby Local Race in Cincinnati, OH, and in the event he or she is adjudged the winner of the official Soap Box Derby Local Race, to participate in the FirstEnergy All-AmericanSoap Box Derby World Championship in the current race year in Akron, Ohio.

Further, I understand and agree that, as a prerequisite to competing in the FirstEnergy All-American Soap Box Derby in Akron, Ohio, that my son/daughter/ward, together with his/her car, shall have undergone and passed an inspection conducted in Akron, Ohio by the International Soap Box Derby, Inc. I further understand and agree that such inspection shall be conducted using the manner and methods deemed appropriate by the International Soap Box Derby, Inc., in its sole discretion, to determine compliance with its rules, spirit and specifications applicable to that division and that the decisions of the International Soap Box Derby, Inc. and its officials regarding qualification, disqualification and compliance with the rules, spirit and specification applicable to that division shall be final and binding upon me, my son/daughter/ward and all other parties.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I (parent/guardian, and/or my son/daughter/ward) may be exposed to or infected by COVID-19 by attending an event that such exposure or infection may result in personal injury, illness, permanent disability, and death. understand and agree that this release includes any claims based on the actions, omissions, or negligence of the ISBD, its employees, volunteers, participants or others, whether a COVID-19 infection occurs before, during or after participation in any ISBD sanctioned event.

Event guidelines is subject to change based on state and local guidelines.

Finally, I, as such parent or guardian, in consideration of the benefits received as a result of the participation herein, and for the mutual benefits received by myself and my child and the other participants herein, hereby waive and release any and all claims, rights, causes of action, demands or otherwise, whether for personal injuries, property damage, or any other loss, damages or expenses which I, as a parent/guardian, and/or my son/daughter/ward may have against the Local Soap Box Derby, its sponsor, the International Soap Box Derby, Inc., and/or its sponsors, agents, employees, full or part-time, or associates of any status whatsoever, arising from or in any manner related to my son's, daughter's or ward's participation in the Local Soap Box Derby, the FirstEnergy All-American Soap Box Derby and/or any activities incidental or related thereto.

Parent/Guardian Signature*

Date*

Date

Local Race Director

Local Race City Organization*

I, Stan Kokotajlo, the Local Race Director of the official Soap Box Derby Local Race being conducted by Cincinnati, OH (Race City), have read the statement about, signed by the entrant and his or her parent/ guardian, and understand the facts therein to be true. I have inspected his/her car and, in my opinion, it meets all construction requirements for the Stock, Super Stock, or Masters division.

Date