MUST BE COMPLETED IN FULL AND APPROVED PRIOR TO COMPETITION

Transcription

1 2015 Youth Membership & Competition Application SPRINT CAR DIVISON ONLY To be completed by all applicants for the SPRINT Car DIVISION under the age of 18 and his/her parents or legal guardians SPRINT CAR DIVISION MUST BE COMPLETED IN FULL AND APPROVED PRIOR TO COMPETITION INFORMATION (PLEASE PRINT CLEARLY): Name: Date of Birth: Grade Level: Drivers License #: State: Name You Race Under (Ex: JR, Bobby) Mailing Address: City/State/Zip: Phone Number: address: PARENT/GUARDIAN INFORMATION: Father/Guardian: Mother/Guardian: Mailing Address: City/State/Zip: Phone Number: address: CAR INFORMATION: Car Owner: Chassis: Car Number: Engine: WINNINGS MADE PAYABLE TO: Name: Mailing address if different from above: Street or PO Box Apt # City, State, Zip US Social Security #: -OR- Federal Tax ID (EIN)#: Enter your Tax ID Number (TIN) on the appropriate line. The TIN provided must match the name given on the Name line to avoid backup withholding. For individuals, this is your social security number (SSN). For other entities, it is your employer identification number (EIN). Certification The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, X Sign Here X Date World Racing Group has a policy that individuals under the age of eighteen (18) are not permitted to compete in any World Racing Group Sprint Car sanctioned racing activity (including World of Outlaws Sprint Cars) with the following exception: An individual under the age of eighteen (18) who fully completes this Application Form; provides sufficient proof of auto racing experience as deemed acceptable to the Competition Eligibility Panel ( Panel ) formed by World Racing Group; seeks to race in a class and at a track(s) acceptable to the Panel; and purchases a Supplemental Participant Accident Medical Access Policy through a World Racing Group approved insurance carrier (minimum $250,000), may be permitted to compete in the event(s) as approved by the Panel in its sole discretion. The burden will rest solely with the applicant, and World Racing Group, with the approval of the Panel, shall determine in its sole discretion whether a World Racing Group Limited License shall be issued to the applicant based on a host of criteria including, but not limited to: (1) applicant s age; (2) applicant s racing resume; (3) applicant s maturity; (4) racing division; (5) racing facility; and (6) length of track. The applicant s parents or legal guardians will be required to fully execute a waiver and release as deemed necessary by World Racing Group and will be required to be in attendance at any and all events that applicant is approved to compete. World Racing Group reserves the absolute right to withdraw the World Racing Group Limited License with or without cause and at any time which shall not be reviewable by the World Racing Group Appellate Panel, Competition Panel, or legal tribunal. Furthermore, applicant understands and acknowledges that the granting by World Racing Group of the World Racing Group Limited License is a privilege based on a finding of competency in the designative racing division, among other things. THE WORLD RACING GROUP LIMITED LICENSE WILL APPLY ONLY TO THOSE EVENTS SPECIFICALLY DESIGNATED AND APPROVED BY WORLD RACING GROUP World Racing Group Youth & Competition Application - SPRINT

2 RACE(S) SEEKING TO COMPETE: #1) Date: Track: Division: #2) Date: Track: Division: #3) Date: Track: Division: #4) Date: Track: Division: #5) Date: Track: Division: #6) Date: Track: Division: #7) Date: Track: Division: #8) Date: Track: Division: #9) Date: Track: Division: ADDITIONAL MEMBER INFORMATION: Please list tracks if previously participated in competition: Please list divisions raced, # of years at each division, and # of races per division: Highest division raced: Family racing experience (if any): # of years raced: Racing schools attended: RACING REFERENCES Name: Relationship: Address: Phone #: (complete address-mailing address/city/state/zip) Name: Relationship: Address: Phone #: (complete address-mailing address/city/state/zip) Name: Relationship: Address: Phone #: (complete address-mailing address/city/state/zip) World Racing Group Youth & Competition Application - SPRINT

3 Additional information about applicant: Applicant s Signature Print Name Date Parent/Legal Guardian #1 Signature Print Name Date Parent/Legal Guardian #2 Signature Print Name Date FEES Non-Refundable Youth Driver Application Fee $150 DIRTcar Sprint Car $125 TOTAL DUE: PAYMENT INFORMATION: If paying by check or money order, make payable to DIRTcar Racing Expiration Date: Name as it appears on card: Amount to be charged: Signature: FOR OFFICE USE ONLY Approved By/Date: Amount Received: Received By: Date: Please retain a copy and/or your receipt to supply as verification until you receive your license by mail. Application must be complete before membership will be considered. MAIL COMPLETED APPLICATION WITH PAYMENT AND PROOF OF HEALTH INSURANCE TO: World Racing Group, Attention: Memberships, 7575-D West Winds Boulevard, Concord, NC World Racing Group Youth & Competition Application - SPRINT

4 2015 DIRTCAR RACING MEMBERSHIP & COMPETITION INDEMNITY/RELEASE (To be completed by all applicants for the SPRINT CAR DIVISION under the age of 18 and his/her parents or legal guardians) I HEREBY CERTIFY that any license hereunder is granted for the sole purpose of enabling me to participate in the furthermore of an enterprise, to wit, a race, or other motorsports-related activity. My presence in, about, or enroute to or out of any premises where DIRTCAR RACING sanctioned events are presented is in furtherance of that DIRTCAR RACING event. I HEREBY AGREE that by signing this Competition Application that I will abide by all rules and regulations as set forth by DIRTCAR RACING including, but not limited to, the following: (1) I agree to abide by all rules and regulations, including car specifications and safety rules; (2) I agree that I shall be the sole spokesperson for myself, the car owner, and the race crew in all matters pertaining to the compliance with the rules and regulations, and I agree and understand that I am responsible for the conduct of my crew; (3) I agree and understand that by submitting my race car for various technical and safety inspections, I certify that the race car meets all rules and regulations for participation in DIRTCAR RACING sanctioned event, and I understand that the burden of proof will rest upon me to show that I am in compliance with all of the DIRTCAR RACING rules and regulations, and I understand that any violation of such rules and regulations may result in confiscation of illegal parts, fines, suspension, and/or loss of points; (4) I agree to appropriately use all required stickers, decals and patches and I understand that failure to do so may result in loss of points and forfeiture of all money and awards for the event; (5) I agree that all decisions of DIRTCAR RACING race officials, or track officials, regarding the interpretation and application of the DIRTCAR RACING rules, regulations and the scoring of positions (race day decisions), shall be non-litigable. Any disputes regarding the interpretation and application of the DIRTCAR RACING rules, regulations and the scoring of positions shall be fully and finally adjudicated by an independent Appellate Board to be promptly created by DIRTCAR RACING, promoters, team owners, drivers, and crew members, and subject to the DIRTCAR RACING Appeals Process and Regulations. I further covenant and agree that I will not initiate any type of legal action against DIRTCAR RACING, or a DIRTCAR RACING promoter, to challenge such decisions, to seek monetary damages, to seek injunctive relief, or to seek any other type of legal remedy. I agree that my sole remedy is the pursuit of an appeal of the decision of the Appellate Board in this regard. I understand that if I pursue such legal action, which expressly violates this provision, then I expressly agree to reimburse DIRTCAR RACING, or the DIRTCAR RACING promoter, for all of its attorney s fees and costs in defending against such legal action; (6) I hereby assign to DIRTCAR RACING and DIRTCAR RACING Sponsors the non-exclusive rights to my image and likeness, and the image of my vehicle, whether portrayed in still or action pictures, drawings, or other artistic renderings, relating to or depicting my participation in DIRTCAR RACING sanctioned events; but only in connection with advertising and promotions relating to the Event and the 2014 & 2015 Series. (7) I further understand that there is no express or implied warranty of safety resulting from publication or compliance with the DIRTCAR RACING rules, and that they are intended merely as a guide and are minimum requirements for the conduct of the sport and are in no way a guarantee against injury or death to participants, spectators, or others; (8) I understand that I am not an agent or employee of DIRTCAR RACING or any DIRTCAR RACING sanctioned race track. Further, I understand that I am solely responsible for compensating my employees, agents or pit crew members. I also assume full responsibility for reporting or filing any reports or tax returns with the appropriate authorities on any and all earnings or funds received as a result of my participation in DIRTCAR RACING sanctioned racing events, including, but not limited to, Federal Social Security taxes, Federal income taxes, State income taxes, Federal and State withholding taxes, unemployment taxes and workers compensation insurance; The undersigned acknowledges that auto racing and related events are HAZARDOUS activities which carry with them significant risk of personal injury, death, or property damage. I also understand that there are natural, mechanical, and environmental conditions and risks which independently or in combination with the activities may cause property damages or severe or even fatal injuries to me or others. I have made a voluntary choice to participate in the activities. I agree to accept all responsibility for the risks, conditions and hazards which may occur whether or not they are known or contemplated by me. Except as set forth below, I hereby expressly assume any and all of the foregoing risks including the risks of injury, death, or property damage and accept sole responsibility for the safety and medical insurance costs of the participant. I further agree to forever release and hold harmless and indemnify DIRTCAR RACING, its subsidiaries, directors, officers, agents, employees, officials, assigns, promoters representing races or other events under DIRTCAR RACING sanction, the owners and lessees of premises on which DIRTCAR RACING sanctioned events are presented, and participants thereon, for all accidents, losses, injuries (including, but not limited to death), or other casualty arising out of my participation in, about, or enroute to and out of the premises where DIRTCAR RACING sanctioned or operated racing events or related activities are presented. By signing this release, I understand that any and all risk (including those set forth above) are expressly assumed by me and all claims or potential claims are expressly waived in advance. I verify that I am in good health and have no conditions that would impact my participation in auto racing or its related activities. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE MEMBERSHIP AND COMPETITION LICENSE IMDEMNITY/RELEASE, and further agrees that no oral representations, statements or inducements being made to me and intend my signature to be a complete and conditional release of all liability to the greatest extent allowed by law. Applicant s Signature Print Name Date Parent or Legal Guardian #1 Signature Print Name Date Parent or Legal Guardian #2 Signature Print Name Date World Racing Group Youth & Competition Application - SPRINT

5 NOTARY PUBLIC AFFIRMATION Commonwealth of County of On this, the day of, 20, before me a notary public, the undersigned officer, personally appeared (applicant), (parent/legal guardian #1), and (parent/legal guardian #2), known to me (or satisfactorily proven) to be the person whose names are subscribed to the within instruments, and acknowledged that he/she executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal. Notary Public: (Printed name) Date: (Signature) My Commission Expires: World Racing Group Youth & Competition Application - SPRINT

6 7575-D West Winds Boulevard Concord, NC (office) (fax) POLICY FOR APPLICANTS FOR SPRINT CAR DIVISION UNDER THE AGE OF 18 World Racing Group has created this program whereby competitors age 16 or 17 who wish to compete in any World Racing Group sanctioned event in the Sprint Car division (including World of Outlaws Sprint Car Series events) and who meet certain criteria may be permitted to obtain a DIRTCAR RACING Youth License, thereby permitting them to participate in designated events and/or designated series with or without limitations. The criteria include: (1) Submission of a non-refundable youth driver application fee of $ (2) Completion of the 2015 World Racing Group Youth Membership & Competition License Application (3) Approval from the World Racing Group Competition Eligibility Panel (comprised of a cross section of members from the racing community) must be granted; and, (4) Purchase of Supplemental participant Accident Program Insurance Policy (minimum $250,000 excess medical) with World Racing Group approved insurance carrier (Canadian residents competing only in Canada are exempt from this last requirement due to the Canadian Universal Health Care Program) or (5) Proof of insurance policy on minor by parent and/or legal guardian. The applicant will be required to demonstrate proof of auto racing experience as deemed acceptable to the Competition & Eligibility Panel which will review the application based on a host of criteria including: (1) Applicant s age (2) Applicant s racing resume (3) Applicant s maturity (4) Sanctioned class (5) Racing facility(ies) (6) Length of track Should you have any questions regarding eligibility or the status of your youth application, please call DIRTcar Member Information at (704) World Racing Group Youth & Competition Application - SPRINT

7 7575-D West Winds Boulevard Concord, NC (office) (fax) COMPETITION ELIGIBILTY PANEL PROCESS & REGULATIONS SPRINT CAR DIVISION 1. World Racing Group has established a Competition Eligibility Panel ( Panel ) to determine the eligibility of a race car driver under the age of eighteen ( Applicant ) who seeks to compete in the DIRTcar Sprint Car division, which includes the World of Outlaws Sprint Car Series, World Racing Group or World Racing Group affiliate (World of Outlaws, DIRTcar, etc.) sanctioned event(s). 2. Individuals 16 or years of age with the prior written consent of both parents/legal guardians have the right to motion the Panel for permission to compete in a World Racing Group or World Racing Group affiliate event(s). 4. The motion must be in writing and shall be sent to World Racing Group c/o DIRTcar Memberships, no less than thirty (30) days prior to the event(s) that the Applicant seeks to compete. The motion shall be sent by certified mail or another form of confirmed delivery (i.e., Federal Express). The Applicant must fully and accurately complete the 2015 World Racing Group Youth Membership & Competition Application. 5. There can only be a hearing of the motion before the Competition Eligibility Panel if its Chairman ( Chairman ), in his sole discretion, first determines that the 2015 World Racing Group Youth Membership & Competition Application is complete in full. The Chairman shall have the right to return any incomplete Application Form to Applicant for re-submission. 6. The Chairman is the administrative member, but has no vote, except to break ties. The Chairman shall conduct the meeting, organize deliberations, and inform the interested parties of the decision. 7. The Chairman shall determine in his unfettered discretion when any member of the competition eligibility panel must recuse himself/herself from a hearing for reasons of conflict. 8. As Panel vacancies arise, World Racing Group shall, from time to time, name replacements in its sole discretion. 9. Competition Eligibility Panel participation in a hearing by any three (3) or more panel members shall constitute a valid quorum to act. Panel members may participate by telephone, teleconference, video-conference, computer conference, in person, or any other forum chosen by the Chairman. 10. A majority of the Panel members participating and voting must concur whether to permit the Applicant to compete in a specified World Racing Group or World Racing Group affiliate sanctioned event(s) by a standard of preponderance of the evidence with the burden resting on the Applicant. 11. The actual procedure for the hearing shall be determined by the Chairman, but shall roughly follow the following format: a. The completed 2015 World Racing Group Youth Membership & Competition Application shall be put into the record by the Chairman. b. At any time during the hearing, the Competition Eligibility Panel may seek additional information from the Application at their discretion. Applicant and his/her parents/legal guardians shall be available by phone during the hearing should the Competition Eligibility Panel seek additional information. c. The Competition Eligibility Panel will deliberate in private and make any determination, decision, or recommendation by a majority vote of those members participating and actually voting ( Actually voting means not abstaining or not having been recused). Criteria that will be evaluated by the Panel include, but are not limited to, age of Applicant, racing resume, track length, car class, number of laps, and references. d. Lastly, all interested parties shall be reasonably notified of the Competition Eligibility Panel s decision. 12. By filing the motion, the Applicant understands that the decision of the Competition Eligibility Panel is final and legally binding with no right of appeal. Should an Applicant s Motion be denied, Applicant may re-motion the Panel no earlier than three (3) months following the Panel s prior decision on the Applicant. Should Applicant s motion be granted, Applicant will be required to purchase a Supplemental Participant Accident Excess Medical Insurance Policy (minimum $250,000) for all events approved by the Competition Eligibility Panel (Canadian residents racing in Canada only excluded) and provide proof of such insurance to World Racing Group. # # # World Racing Group Youth & Competition Application - SPRINT