Kids Power Wheel Demo Derby Online Registration

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Registration Form

All Children who wish to participate in this event must pre-register.

Kids Name

First

Last

Parent / Guardian

First

Last

Relationship To Child

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Car

Vehicle Color / Style Description

If Known at Registration (Not Required)

Confirmation

I give the fair permission to publish any placings you receive and pictures in the newspaper, on radio, and/or on the website.
I acknowledge that upon submitting this form, my orders are final and can no longer be canceled.

Driver Rules

Minor Release / Signature

Clear Signature

Being the parent and/ or Legal guardians I hereby consent to this entry being admitted to the Sullivan County Fair Association Demolition Derby being held at the fairgrounds Rt. 154 Forksville Pa. And that said minor that I hereby expressly release the Sullivan County Fair Association and any sponsors and all of their associates for any injuries of any kind or nature which may occur or be received as a result of said minors’ participation in said Derby. And I hereby expressly waive all claims for injuries that may occur should said minor be injured while being a contestant in said contest. Parent and/or Legal Guardian: Subscribed and sworn.

Upload Waiver

Click or drag a file to this area to upload.

Sign & Attach "Event Participation Agreement" Bring Along With You As Well!