MPX RACING

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_______

 

(SEAL) _________________________________

NOTARY PUBLIC SIGNATURE

MPX Racing

2750 South Unionville Rd.
Sebewaing, Michigan 48759
(989) 395-8757
Or fill out our Contact Form here.