MINOR RIDER PERMISSION
Must be Notarized!
I, ________________________________ (parent/guardian name), give my son/daughter
___________________ (minor participant name) permission to ride motocross at MPX RACING on________________________ (date), 20_______ (year).
In addition, I grant permission to _________________________________ (responsible party
name) to sign all liability, release and registration forms at the track and to give consent for medical treatment of _____________________________ (minor participant name) if needed.
Signature of Parent or Guardian Date
_________________________ (______) _______________
Printed Name of Parent or Guardian Phone
STATE OF ______________________ §
COUNTY OF ___________________ §
Before me, the undersigned authority, on this day personally appeared____________________
___________________, known to me to be the person whose name is subscribed to the foregoing instrument, and upon his/her oath acknowledged to me that he/she executed the same for the purposes therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS _______ DAY OF ____________, 20_______
NOTARY PUBLIC SIGNATURE