Minor Rider Permission Slip

Must Be Notarized!

I, ________________________________________(parent/guardian), give my son/daughter _____________________________________(minor participant name) permission to ride motocross at MPX Racing, Sebewaing, MI on ______________.(date) 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 Parent 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 _________________, 2011

(SEAL)

___________________________________________

NOTARY PUBLIC IN AND FOR

______________________COUNTY, _____________