PARK COUNTY FAIR & POWELL LION'S CLUB DEMOLITION DERBY
ENTRY FORM AND WAIVER

Mail to: Powell Lions Club, Box 1, Powell, WY 82435 or bring completed entry form to gate at least 1 hour before Drivers Meeting on the Date of Derby.
I do hereby waive and/or rescind any and all rights to file for or claim compensation or damages from the Park County Fair & Powell Lion's Club Demolition Derby, sponsoring organization, or any official at the Derby for injuries or damage I may encounter while participating in the above said Derby.
NOTICE: Any participants 18 years of age or younger must have parental consent signed and notarized. All are required to have picture identification for verification of age / identity - there will be no exceptions.

(Driver)
Print Name _________________________________________________     Driver's Date of Birth ___________

Signature___________________________________________________     Date Signed by Driver________

(Pit Crew #1)
Print Name _________________________________________________     Pit Crew #1 Date of Birth ___________

Signature___________________________________________________     Date Signed by Pit Crew #1________                        

(Pit Crew #2)
Print Name _________________________________________________     Pit Crew #2 Date of Birth ___________

Signature___________________________________________________     Date Signed by Pit Crew #2________     

Announcer Information
Driver's Name______________________________________________________________(Print clearly for Announcer)

Car Year __________Make ______________Model ____________Number _______

SPONSORS __________________________________________________________________________________________
 

Below is for Announcer notes:
Heat #____         

Pin Prize: Y/N                Pin Prize  Grudge: Y/N                Pin Prize  Main: Y/N

Finishing Position:            1 or 2 (advances to Main)

Advance to Main from Grudge:     1 or 2