• Driving Skills for Success Registration

    Bismarck, ND July 28, 2026 - VFW Sports Arena Please have parent complete form with participant if under 18 years of age.
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Waiver 1: Assumption of Risk - Minor

    North Dakota Department of Transportation
    608 E Boulevard Ave
    Bismarck, ND 58505
    dot.nd.gov
    1-855-637-6237
    TTY: 711

    PARENT OR GUARDIAN’S AGREEMENT OF
    ASSUMPTION OF RISK AND MEDICAL RELEASE


    Acknowledgment and Assumption of Risk
    The undersigned parent and/or legal guardian acknowledges that he/she is aware of the dangers and the risks to the participant’s person and property involved in voluntarily participating in: Driving Skills for Success.


    The undersigned parent and/or legal guardian and participant understand that this volunteer activity involves risk of physical injury to the participant. Because of the dangers of participating in this activity, the undersigned parent and/or legal guardian and participant recognize the importance to, and the undersigned parent and/or legal guardian and participant agree to, fully comply with the applicable laws, policies, rules and regulations, and any supervisor’s instructions regarding participation in this activity.


    The undersigned parent and/or legal guardian and participant understand that the North Department of Transportation (NDDOT) and VFW Sports Center does not insure participants in the above-described activity, that any coverage would be through the personal insurance of the undersigned parent and/or legal guardian, and that the NDDOT and VFW Sports Center has no responsibility or liability for injury resulting from this activity.


    The undersigned parent and/or legal guardian acknowledges that the participant voluntarily elects to participate in this activity with knowledge of the danger involved and hereby agrees to accept and assume any and all risks of property damage, personal injury, or death.


    The undersigned parent and/or legal guardian and participant further consent to receive medical treatment which may be deemed advisable in the event of injury, accident, or illness during this activity or event.


    I, the undersigned parent and/or legal guardian on the participant, affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this form I am assuming the risk of any losses the participant may sustain as a result of participation in the activity. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.


    READ BEFORE SIGNING *To be signed by adults if the participant is under 18 years of age.

  • Waiver 2: ND DOT Talent Release

    North Dakota Department of Transportation
    608 E Boulevard Ave
    Bismarck, ND 58505
    dot.nd.gov
    1-855-637-6237
    TTY: 711

    TALENT RELEASE FORM 

    I give permission to the North Dakota Department of Transportation (NDDOT) to capture and publish my likeness using still or motion media (photo and/or video) for use by NDDOT and/or its subsidiaries, including but not limited to its use on NDDOT websites, publications, videos, advertisements, informational material and signage. I understand and agree that NDDOT may, in its sole discretion, edit, crop, touch up or otherwise alter a photo containing my image to improve the picture quality, composition, contrast and for other purposes. Further, I understand and agree that I shall receive no compensation of any kind now or in the future. I understand that the photos/video taken remain the property of North Dakota Department of Transportation for future discretionary use and release the NDDOT and state of North Dakota from any and all liability arising out of the use of my likeness and agree not to make any claim against the NDDOT as a result of usage.

  • Waiver 3: Seatbelt Convincer

    Dickinson Police

    RELEASE AND WAIVER OF LIABILITY AGREEMENT
    “Convincer” Simulator


    I acknowledge that I have voluntarily applied to participate in the “Convincer” slow speed crash simulating apparatus at Vision Zero Driving Skills for Success event being held in Bismarck, ND at the VFW Sports Center.


    I AM AWARE THAT THIS ACTIVITY IS/OR COULD BE HAZARDOUS AS IT SIMULATES A SLOW SPEED CRASH AND THAT I COULD BE INJURED. I AM VOLUNTARILY PARTICIPATING IN THIS ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.

    As consideration for being permitted to participate in the Convincer Simulator, I forever release, the Dickinson North Dakota Police Department and the City of Dickinson, any organizations or coalitions and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively "releases") from any and all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my participation in this activity, (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by any Release, or (iii) the condition of the premises where these activities occur, whether or not I am then participating in the activities. I also agree that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives will not make a claim against, sue or attach the property of any release in connection with any of the matters covered by the foregoing release.


    I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND THE DICKINSON POLICE DEPARTMENT, CITY OF DICKINSON NORTH DAKOTA AND I AM SIGNING IT OF MY OWN FREE WILL.


    If signed by Parent or Guardian: I verify that the dangers of the activities and the significant of this Release and Waiver were explained to the Participant and that the Participant understood them.

  • Waiver 4: Uhaul

     

    Uhaul

    Liability Waiver Form

     

    To the best of my knowledge, I am in good physical condition and fully able to participate in this course.  I am fully aware of the risks and hazards connected with the participation in this event, including physical injury or even death, and herby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me and my property.  I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this course. 

     

    I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, U-Haul International, Inc., their officers, servants, agents, and employees; the State of North Dakota, the VFW Sports Center,  their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the event is being conducted.

     

    I HEREBY RELEASE AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY CLAIM OR LAWSUIT FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH, BY ME, MY FAMILY, ESTATE, HEIRS, OR ASSIGNS, ARISING OUT OF PARTICIPATION IN THE EVENT, INCLUDING BOTH CLAIMS ARISING DURING THE ACTIVITY AND AFTER I COMPLETE THE ACTIVITY, AND INCLUDING CLAIMS BASED ON NEGLIGENCE OF OTHER PARTICIPANTS OR THE RELEASED PARTIES,

    WHETHER PASSIVE OR ACTIVE.

     

    I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of North Dakota.

     

    In signing this release, I acknowledge and represent that I HAVE READ THE FORGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.


    If signed by Parent or Guardian: I verify that the dangers of the activities and the significant of this Release and Waiver were explained to the Participant and that the Participant understood them.

  • Waiver 5: Assumption of Risk - Adult

    North Dakota Department of Transportation
    608 E Boulevard Ave
    Bismarck, ND 58505
    dot.nd.gov
    1-855-637-6237
    TTY: 711

    ADULT AGREEMENT OF
    ASSUMPTION OF RISK AND MEDICAL RELEASE


    Acknowledgment and Assumption of Risk
    The undersigned acknowledges that he/she is aware of the dangers and the risks to the participant’s person and property involved in voluntarily participating in: Driving Skills for Success.


    The undersigned participant understand that this volunteer activity involves risk of physical injury to the participant. Because of the dangers of participating in this activity, the undersigned participant recognize the importance to, and the undersigned participant agree to, fully comply with the applicable laws, policies, rules and regulations, and any supervisor’s instructions regarding participation in this activity.


    The undersigned participant understand that the North Department of Transportation (NDDOT) and VFW Sports Center does not insure participants in the above-described activity, that any coverage would be through the personal insurance of the undersigned and that the NDDOT and VFW Sports Center has no responsibility or liability for injury resulting from this activity.


    The undersigned parent and/or legal guardian acknowledges that the participant voluntarily elects to participate in this activity with knowledge of the danger involved and hereby agrees to accept and assume any and all risks of property damage, personal injury, or death.


    The undersigned participant further consent to receive medical treatment which may be deemed advisable in the event of injury, accident, or illness during this activity or event.


    I, the undersigned affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this form I am assuming the risk of any losses the participant may sustain as a result of participation in the activity. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.

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