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Track 21 One Day ADULT Waiver
You must be 18 and above with correct ID to use this form.
25
Questions
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1
This waiver will be used on this day:
*
This field is required.
This is a One Day Waiver, so please choose the correct date you are planning to be here at Track 21!
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2
Are you part of a larger group that is meeting here?
Enter a common name, company name, etc and we can search for your attendees by this.
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3
Participant's Name
*
This field is required.
As it appears on your ID
First Name
Last Name
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4
What is your birthday?
*
This field is required.
-
Date
Year
Month
Day
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5
Gender
*
This field is required.
Male
Female
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6
Racing Nick Name -
This will show up on the scoreboard, so please keep it clean!
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7
Your Address
*
This field is required.
This is used for filing information. NONE OF YOUR INFORMATION IS EVER SOLD TO ANYONE!!
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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8
Phone Number
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9
Have you driven a go kart in the previous 12 months?
*
This field is required.
YES
NO
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10
Would you like to save money or Karting, Laser Tag or Mini Golf?
Fill out your email address below and the Track 21 Newsletter always has coupons, promo, etc. The initial email will include a discount coupon just to say thank you! Your information will never leave Track 21 and you can choose to unsubscribe at anytime!
example@example.com
Confirm Email
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11
Please read and check the box below agreeing to the terms in order to continue
*
This field is required.
Inconsideration of allowing me to operate a go-kart, participate in laser tag or mini golf at Track 21, I hereby release Track 21, its members, agents,employees, landlord, successors or assigns, from any and all liability, claims,demands, actions and causes of action whatsoever, whether foreseen or unforeseen, arising out of or related in any way to my renting and operating a go-kart, participating in laser tag or mini golf at Track 21 that may result in injury, death or property damage or loss or other damages to me or my family,estate, heirs or assigns and further to save and hold harmless Track 21, its members, agents, employees, landlord, successors or assigns, from all liability whatsoever for personal injury, property damage or loss or wrongful death caused by its negligence.I understand that these activities(and any others I may participate in while at Track 21) are dangerous and may become more hazardous or dangerous during the time I am on the premises of Track 21, that the risk of injury from the operation of a go-kart, participating in laser tag or mini golf is significant, including the potential for serious bodily injury, paralysis and death; that I am aware of all the risks and hazards inherent with operating a go-kart, participating in laser tag and/or mini golf at Track 21 and hereby voluntarily assume all risk of loss, damage and injury, including death, that may be sustained by me or any property of mine while at Track 21. This release shall be binding upon my family, estate, heirs or assigns. This release shall continue in effect each time I operate a go-kart or participate in laser tag or mini golf at Track 21 Indoor Karting.
Agree
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12
That I have read the foregoing Liability Release, understand it and sign it voluntarily
*
This field is required.
Agree
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13
That I am at least 62 inches tall for the adults karts
*
This field is required.
Agree
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14
That I am not pregnant
*
This field is required.
Agree
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15
That I have not consumed alcohol or drugs, which may affect my ability to drive a go-kart or participate in laser tag or mini golf in a safe manner;
*
This field is required.
Agree
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16
That I do not suffer from a heart condition, high blood pressure or other medical condition and or current or previous injury which may be aggravated by my operating a go-kart, playing laser tag or mini golf.
*
This field is required.
Agree
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17
That I will wear a helmet and
enclosed shoes
while operating a go-kart or otherwise while in or around the racetrack
*
This field is required.
Agree
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18
That any type of loose clothing such as, but not limited to, scarves, hoodies, etc will be tucked safely into my clothing, or removed prior to racing. Also hair below the neck will be confined at all times that I am operating the go kart
*
This field is required.
Agree
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19
That I will stay seated in the go-kart with the safety belt fastened until instructed by a track official to remove the safety belt and get out of the go-kart
*
This field is required.
Agree
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20
That I will obey all rules and regulations of Track 21 for all activities including karting, laser tag and mini golf
*
This field is required.
Agree
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21
That I will closely observe and follow the instructions of all facility personnel and posted signs
*
This field is required.
Agree
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22
That this agreement is continuing and shall remain in effect every time I use this facility
*
This field is required.
Agree
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23
That I am 18 years or older WITH identification stating my date of birth
*
This field is required.
Agree
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24
By signing the foregoing Liability Release, I acknowledge and represent that all the above statements are true
*
This field is required.
*ALL individuals must be prepared to show ID upon request in order to race. Guardians MUST provide proof of guardianship in form of a state document granting rights to signing persons. Any deviations from this will result in you inability to race. While using this site, you are choosing to submit personal information through email/online forms. Your name, address, phone, email address, and any other information you provide are held in strict confidence: We will use this information to process your requests; But we will not intentionally sell, share, or distribute your personal information to third parties, except as required by law.
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25
*
This field is required.
Must have a valid driver license or government ID with picture, name, and birthday to prove age in order to race. Maximum file size: 1024kb. Allowed file types:pdf, doc, docx, jpg, jpeg, png, gif, bmp.
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26
In Order To Sign You Own Waiver You Must Be 18 or Older With A Valid ID Which Shows: Legal Name, Your Picture & Your Birthday
*
This field is required.
Upload a copy of the ID so we may verify you are in fact old enough to sign your waiver. Also please bring the ID with you just in case there is an issue with your waiver we can have you fill one out onsite.
Drag and drop files here
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Min. file size
1.0KB,
Max. file size
: 10.6MB
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27
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Track 21 Adult One Day Online Waiver
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