2010 LUCAS COUNTY FAIR
DEMO-DERBY & Lawn Mower {derby} entry form
Saturday July 31st, 2010
AGE ON EVENT DATE: ________ SOCIAL SECURITY #: _________-______-_________
RELEASE and CONSENT FORM for PARTICIPANTS UNDER 18 YEARS OLD
State of ______________ County of _________________________, I, _______________________________________
Being the parent and / or legal guardian of _________________________ hereby consent to permit ___________________________________________
To enter and / or participate in a RONEY MOTORSPORTS LLC event being held at Lucas Co. Fairgrounds and that said minor is under the legal age of this state.
Namely, age __________ and that I hereby expressly release both the producer and the sponsor and all of their associates for any injuries of any kind or nature that may occur or be received as a result of said minor's participation in said event. And I hereby expressly waive all claims for injuries that may occur should said minor be injured while being a contestant in said contest.
Parents and / or Legal Guardian: _______________________________ Subscribed and sworn to this __________ day of ___________, 20_____. Notary Public _________________________________________
My commission expires ___________________________________
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Entries may be sent to the following address:
Roney Motorsports L.L.C.
115 DeBlanche Ave
Columbus Grove, OHIO 45830
$40 per car
$60 per car DAY of EVENT
q Note make checks/money orders out to: Lucas Co. Ag. Society
Please circle as to which event you are entering!!!
- BIG CAR (no 64-66 Imperials, no 71-76 GM wagons)
- FULL SIZE TRUCK
All entries will receive 2 pit passes for each registration for competition.
(You must have your vehicle with you when you obtain your 2 pit passes.) EXTRA PIT PASSES WILL BE SOLD {$15} AND WAIVER MUST BE SIGNED
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Circle here for……Lawn Mower Demo: ONLY 20 entries will be taken for this event
$20 pre-entry and $30 day of event
Drivers only will receive a pit pass!!
EXTRA PIT PASSES WILL BE SOLD {$15} AND WAIVER MUST BE SIGNED