MAKE CHECKS PAYABLE TO: ELLIE’S HATS
YOUR DONATION GOES DIRECTLY TO ELLIE’S HATS ORGANIZATION AND IS TAX
DEDUCTIBLE! THANK YOU FOR YOUR GENEROSITY!
I, the undersigned, have full knowledge of the risks, both to person and property, inherent with
participating in motor vehicle events. I am voluntarily participating at my own risk in the Car Show being
held on April 22, 2018, at 4260A Entre Court, Chantilly, VA 20151 (the “Car Show”). With this knowledge
and as a partial inducement for being allowed to participate, I do hereby release Integrity Auto, LLC (dba
Casey’s Automotive) and its members, employees, and agents from all claims of bodily injury and
property damages which may arise out of my participation in the Car Show. I attest and verify that I am
lawfully licensed to drive an automobile in the Commonwealth of Virginia and that my automobile is
insured to meet the Commonwealth’s (or other relevant jurisdiction’s) legal liability requirements. I am at
least 18 years old, and I am the person named in the attached registration form. I HAVE READ THIS
FORM AND CERTIFY MY AGREEMENT WITH MY SIGNATURE. I FULLY UNDERSTAND THAT THE
TERMS OF THIS RELEASE SHALL SERVE AS A RELEASE AND ASSUMPTION OF RISK FOR
MYSELF AND MY HEIRS, EXECUTORS, AND ADMINISTRATORS AND FOR ALL MEMBERS OF MY
FAMILY, INCLUDING ANY MINORS ACCOMPANYING ME.