May 2nd & 3rd Portage County Rally Race Registration Form

One double race & One Single race each day in all divisions.
Pre-registration is requested & appreciated.
Pay the day of the rally at check in.
$100 for all 4 races or $30 per race for 3 or less races.
Check Begins at 7am and Ends Promptly at 8am each day.
Pits will be down in run out area on side where the rubber bowl was. Please stay on that side.
(Separate registration form must be completed for more then one division in the same weekend.)

Rally ID #*

If you have not raced in a rally and do not have a rally ID please enter 6 "0" for this field.

have never participated in an All-American Rally before todayhave rallied before and do have a Rally ID # (listed above)

StockSuper StockMasters

Saturday May 2nd Double Elimination RaceSaturday May 2nd Single Elimination RaceSunday May 3rd Double Elimination RaceSunday May 3rd Single Elimination Race

Participant's Name*

First NameLast Name

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Local Race City Organization*

Phone*

Format: (000) 000-0000.

School Grade*

Age*

Date of Birth*

Date

Parent/Guardian Email*

example@example.com

Shirt Size*

What year did you begin racing Soap Box Derby?*

I, First Name* Last Name* , racer of a Soap Box Derby car entered in the official Soap Box Derby Local Race being held in Local Race City* , hereby certify that my car has been built in full compliance with the most current construction plans and rules published by the International Soap Box Derby, Inc. If I win my local race, I agree to represent that Local Race City and waive any claims to compete in the Rally World Championship.

Participant Signature*

Date*

Date

Parent/Guardian's Name*

First NameLast Name

Relationship to Participant*

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

I, First Name* Last Name* (parent/guardian), hereby certify that my above son/daughter/ward, entrant in the Official Soap Box Derby Family Rally being conducted by * , have read the above statement signed 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 Family Rally Race in * and in the event, he or she is adjudged the winner of the Rally Region, to participate in the All-American Soap Box Derby World Championship Race in Akron, Ohio. I also hereby certify that if my son/daughter/ward wins a Rally District position, I agree to the following:

-Any and all expenses incurred in transporting my son/daughter/ward and his or her car to and from Akron, Chio shall be at my sole expense.
- I will cause his or her car to arrive at Derby Downs in Akron, Ohio as required in the Family Rally Program License Agreement and have my son/daughter/ward arrive in Akron, Ohio as required in the Family Rally Program License Agreement.
That my son/daughter/ward's car, upon entry in the All-American Soap Box Derby Rally Championship Race in Akron, Ohio, becomes the property of the International Soap Box Derby, Inc.
- I will meet all deadlines and schedules from time to time established by the International Soap Box Derby, Inc. for the performance of the acts and the submission of documentation and information to the International Soap Box Derby, Inc.
-I will furnish to the International Soap Box Derby Inc. a certificate or certificates in the form provided by the International Soap Box Derby, Inc., certifying that my son/daughter/ward's car constructed by my son/daughter/ward in all respects in accordance with the current Official Rules governing the Soap Box Derby, and to furnish a copy of my son/daughter/ward's birth certificate.
- I understand and agree that, as a prerequisite to competing in the All-American Soap Box Derby Rally Championship Race 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 in its sole discretion, to determine compliance with its rules, spirit and specifications applicable to the division and that the decisions of the International Soap Box Derby, Inc. and its officials regarding qualification and disqualification and compliance with the rules, spirit and specification applicable to the division be final and binding upon me, my son/daughter/ward and all other parties.

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(s), 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 All-American Soap Box Derby Rally Championship and/or any activities incidental or related thereto.

Photographic Release. I grant and convey to the Derby all rights, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness made by Derby or its agents in connection with my providing volunteer services to the Derby.

The ISBD has put in place preventative measures to reduce the spread of COVID-19; however, the ISBD cannot guarantee that you will not become infected with COVID-19. Further, attending any ISBD event could increase your risk of contracting COVID-19.

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. I 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 events.

Parent/Guardian Signature*

Date*

Date

I, Jay Moore * , the Rally Race Director of the official Soap Box Derby Local Race being conducted by Portage County Soap Box Derby* (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.
Rally Race Director Signature________________________
Date_________________