Casey's 2019 Car Show & Spring Fest

Casey’s 2019 Car Show & Spring Fest

Fill Out The Registration Form

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 7th, 2019 (or April 28, 2019 Rain date), 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.

Signature:
Date:




Fill Out The Registration Form

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 7th, 2019 (or April 28, 2019 Rain date), 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.

Signature:
Date: