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Request PDF Registration/Waiver form

Please print off and mail to:
International Chunkin Coalition,
PO Box 214
Greenfield, NH. 03047

             WAIVER, RELEASE AND ASSUMPTION OF RISK AGREEMENT

 
           
This Waiver, Release and Assumption of Risk Agreement (the “Release”) is

entered this ______ day of __________, 201_, by ______________________________  (print here) The Membership of Team Name

of ___________________________________________________,(Home Town/State where machine is kept)  hereinafter, referred to herein a Team Address

“I” or the “Participant” participating in the “Extreme Chunkin’®” as defined herewith below.

Whereas, Participant desires to participate in the construction, modification, development, transportation, set up, assembly, competition, and return of a certain piece of machinery to be used in Extreme Chunkin’® events anywhere and at any time.

Whereas, the International Chunkin Coalition LLC, and The New Hampshire Motor Speedway, collectively referred to as Releasees, seek to limit their liability pursuant to this Release.

 Whereas, Participant acknowledges that by signing this Agreement, Participant is willingly giving up Legal Rights. And, whereas Releasees will not allow Participant to take part in any activity related to Extreme Chunkin’® without the signing of the Release.

 In consideration of granting permission for me to participate in Extreme Chunkin’® and other good and valuable consideration, the sufficiency of which is hereby acknowledged, I hereby agree to the following:

 

            1.  Waiver, Release and Assumption of Risk:  As consideration for permission to participate in Extreme Chunkin’® anywhere and at anytime, I expressly agree to waive any and ALL liability and indemnify and hold harmless the International Chunkin Coalition LLC., The New Hampshire Motor Speedway, their stockholders, officers, all representatives, or agents thereof, (collectively referred to as “Releasees”) and each of their heirs, successors and assigns from and against any and all liabilities, obligations, claims, demands, suits, actions, causes of action, expense (including court costs and attorneys’ fees) or any other matters arising from any acts omissions or consequences, whether foreseen or unforeseen, by Releasees  or any other person or entity whatsoever, in conjunction with my attendance in and participation in Extreme Chunkin’® including, but not limited to, any and all injuries to my person, including illness or death, or property (whether real or personal) or both, or to any other person, including illness or death, or person’s property (whether real or personal), or both, during my presence and participation in Extreme Chunkin’®, and resulting from any cause whatsoever, including my actions while participating in Extreme Chunkin’®.

            Participation in Extreme Chunkin’® activities shall include my participation in any manner whatsoever and in whatever form that may take, whether it be as a contestant, judge, volunteer, performer, paid employee, bystander, or any other form of participation, whether it be as an individual or as part of a group, and shall be deemed participation simply by virtue of any activity related to Extreme Chunkin’®, and any time periods before or after in which set-up (or other preparation) and break-down/clean-up activities take place.

            I fully understand and expressly acknowledge that my participation in Extreme Chunkin’® subjects me to activities that are inherently dangerous activities that can lead to serious bodily injury, including death, and damage or destruction of property, and that unanticipated dangers may arise during such activity.  I hereby expressly assume responsibility for and the risk of injury or harm to my person, including illness or death, or injury or destruction of property from these and any other activities in conjunction with my participation in Extreme Chunkin’, as well as the risk of injury or harm to other persons and property, whether real or personal, and including Releasees, that may be sustained in connection with the stated and associated activities as well as during any period prior thereto I may be anywhere for set-up, preparation or other purposes and any period thereafter that I may be involved in any activity, or other reasons.  I hereby release Releasees from any and all liability for injury, illness, death or property damage to any person whatsoever resulting from any and all activities associated in any manner with the Extreme Chunkin’, as well as the risks involved in being in the vicinity where such activities may be carried on by individuals other than myself.


  2.  Release Binding.  This release shall be binding upon my heirs, beneficiaries, executors, administrators, successors and assigns.

  3.  Voluntarily Giving Up Right to Sue.  I understand that I am voluntarily giving up my right to sue the above described Releasees.

 By signing on the attached page, I acknowledge, represent and certify that I am the age of legal majority, that, as the sole party executing this document on my behalf, I have READ and FULLY UNDERSTAND this Participation Waiver and Hold Harmless agreement, that I am signing it VOLUNTARILY with full intent to be bound by this agreement and that my attendance at and participation in Extreme Chunkin’® is voluntary.

 PLEASE NOTE:  Individuals under the age of eighteen (18) are required to have this agreement executed by their parent or legal guardian in order to participate in Extreme Chunkin’®.  Failure to do so will result in the minor Participant’s exclusion from the premises during the event and any time periods relevant hereto.



 

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

 

PLEASE NOTE:  Individuals under the age of eighteen (18) are required to have this agreement executed by their parent or legal guardian in order to participate in Extreme Chunkin’®.  Failure to do so will result in the minor Participant’s exclusion from the premises during the event and any time periods relevant hereto.

 

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

_______________________________                                  __________________________________

  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

_______________________________                                 __________________________________

  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

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  Individual Participant (Print Name)                         Participant – Signature / Date

 

_______________________________                                 __________________________________

  Individual Participant (Print Name)                         Participant – Signature / Date

 

_______________________________                                  __________________________________

  Individual Participant (Print Name)                         Participant – Signature / Date

 

_______________________________                                  __________________________________

  Individual Participant (Print Name)                         Participant – Signature / Date

 

_______________________________                                 __________________________________

  Individual Participant (Print Name)                         Participant – Signature / Date

 

2016 Extreme Chunkin'® Team Registration Form                                 

Team Name (Machine name):_____________________________________________________

Did you enter in the previous year’s (2015) Competition in New Hampshire?________

Captain’s Name:___________________________________

Captain’s Mailing address:________________________________________________________

Captains Home/Cell Phone:_________________________________

Email address:______________________________

Machine type/division you will enter (circle one) - Air Cannon, Trebuchet, Catapult, Torsion, Human Power

Average distance your machine will throw (This helps place spotters accurately in the field):________________Feet

Fire line passes (7) will be issued generic and will be separate from your ID. They will be added to the team information packets that are picked up when you arrive on the field. Only 7 Fire line passes will be issued. A fire line pass allows you to be in the pit when the machine is being fired – all other members must leave the pit area for safety reasons until the machine has been fired.

*Team Registration opens March 1st 2016 for teams that participated in the 2015 Extreme Chunkin'® event in NH. Teams that participated in this event in 2015 will have the opportunity to sign up ahead of any new teams. New team registration opens May 1st 2016 all applicants will be accepted on a first come first served basis. Please note:  the field is limited so don't delay! Please read the all rules - you must be able to comply with all general and safety rules to enter.

There is NO Registration fee!

Badges/ ID’s - There is a $35 per person badge fee (aka Pit Pass) - all revenue generated from badges goes to fund insurance for all teams. All team members must have a badge. Team members DO NOT need to purchase event tickets. Please submit all team names together on one common form (Please print legibly). Waiver/releases must also be filled out and mailed in with Team Registration. Please make check or money order out to: International Chunkin Coalition LLC, and mail to PO Box 214 Greenfield, NH. 03047 with your registration form. All badges are prepared ahead of the event.

To ensure firing line safety, no machine will be allowed to set up on the field after 8am on any event days. Machines arriving after 8 am on Saturday or Sunday will sit in the back of the pit until the end of the days competition. Once a machine is set on the field, it is the expectation of the ICC that it remains set-up on the field and participating until Sunday 4pm. Its STRONGLY recommended teams arrive Thursday or Friday ahead of the event to set up.

New teams must provide a picture or design concept of your machine for the application to be considered valid (if you have competed in the NHMS Extreme Chunkin'® event before this is not required). Air Cannons must meet ASME requirements. All machines must adhere to the ICC’s safety rules. All machines will have a safety inspection prior to shooting. No passes will be issued to teams arriving without a machine ready to compete in their class. All ICC rules will be enforced, therefore by entering this competition, you are acknowledging that you understand and will comply with all the rules associated with the safe operation and competition of the event.


Notification of acceptance will be posted on www.extremechunkin.com prior to the event in the order applications are received.  To contact us, email at:  extremechunkin@gmail.com

Captains signature:_______________________________________________________

Team Members Full Names (Those that will hold team badges - PLEASE PRINT NAMES):

1.___________________________________________________________

2.___________________________________________________________

3.___________________________________________________________

4.___________________________________________________________

5.___________________________________________________________

6.___________________________________________________________

7.___________________________________________________________

8.___________________________________________________________

9.___________________________________________________________

10.__________________________________________________________

11.__________________________________________________________

12.__________________________________________________________

13.__________________________________________________________

14._________________________________________________________

15.__________________________________________________________

16.__________________________________________________________

17.__________________________________________________________

18.__________________________________________________________

19.__________________________________________________________

20.__________________________________________________________

Mail (with badge fees) to: International Chunkin Coalition, PO Box 214 Greenfield, NH. 03047