Register Air Cooled

    Buggy Name

    Buggy Number

    Owner

    Email Address

    Address

    Phone 1

    Phone 2

    Only seven persons per buggy allowed in pits, Please print all their names here, Signatures will be required on a release form at time of registration, No one under the age of 16 years of age is allowed in the pits. Minors must have a parent or guardian sign the release form and provide official proof with ID, such as school ID card, copy of birth certificate or driver's license.


    Entry Level

    Driver

    Age

    Crew 1

    Age

    Crew 2

    Age

    Crew 3

    Age

    Crew 4

    Age

    Crew 5

    Age

    Purse Payment Information


    Name

    Phones

    Address (If different than above)

    Please Read

    This is the text of the release that drivers and pit crew members and parent or guardian of crew members 16 or 17 must sign at registration: I, first party, for and in consideration of the privileges of applying, entering and / or participating in a moving vehicular sporting event, sponsored by Swamp Buggy lnc., and other valuable considerations received from or on behalf of Swamp Buggy Inc. , second party, a non-profit corporation existing under the laws of the State of Florida (whenever used herein the terms "first party" and "second party" shall include singular and plural, heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, whenever the context so admits or requires) hereby remise, release, acquit, satisfy, and forever discharge the said second party, and all its agents, representatives, and employees ,of and from all, and all manner of action or actions, cause and causes of actions, suits, debts, dues, sums of money, accounts, reckoning, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, executions, claims and demands whatsoever, in law or in equity, which said first party ever had, now has or which any personal representative, successor, heir or assign of said party, hereafter can, shall or may have, against said second party, and all of its agents, representatives and employees, for, upon or by reason of any matter, cause or thing whatsoever, from the beginning of the world to the day of these presents.