2017 Emerald Coast Electrathon Classic 120
2017 Emerald Coast Electrathon Classic 120
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Advisor(s)
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Advisor(s) Email(s)
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Primary Advisor’s Phone Number
School/Organization
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Contact Mailing Address
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City/State/Zip
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Daytime Phone (and Ext)
Car Number and Class Request:
(IE approves numbers) (HS, Open, Solar)
#______Class ___ #______Class ___
#______Class ___ #______Class ___
#______Class ___ #______Class ___
#______Class ___ #______Class ___
2017 Emerald Coast Electrathon Classic 120
Advisors: Signing this registration form demonstrates your commitment to abide by the rules and regulations established by Electrathon America and Emerald Coast Electrathon (ECE). You also signify the following:
2017 Emerald Coast Electrathon Classic 120
- Your team members are knowledgeable of the Electrathon America rules for 2017.
- Your team members and advisors maintain a professional relationship with each other, their colleagues, and ECE personnel by recognizing and promoting the following:
a)Student satisfaction
b)Integrity
c)People working together cooperatively
d)Respect for all people
e)Enhancing the reputation of ECE
f)Refraining from the use of profanity
g)Being truthful
h)Minimize gossip and negative comments about other ECE members, their cars, or ECE personnel
3You have attached a copy of your team’s current Electrathon America registration for each car entered for the current race.
4Your team has attached a team listing. ALL team members including advisors, parents, etc. will sign a waiver from the race insurance carrier prior to entering the track infield.
5Each driver has attached a ECE Driver Medical Authorization, Release and Liability Waiver Form. The race insurance carrier may requirement a separate waiver for drivers as well where the original race form must be used as well.
6Your team members and advisors will maintain confidentiality while problems between students, advisors, volunteers, track officials, and/or ECE staff are being resolved.The following steps will be followed, as needed, to resolve disagreements:
- Direct conversation
- File an ECE complaint form
- Review of complaint by ECE Director, Manager, and/or Advisory Board
- Resolution between the advisor, ECE staff, and if necessary, school principal or other administrator
Team Advisors and Members
Team Advisors
Print or Type NameSignatureDate
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- ______
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Team Members
Print or Type NameAgeSignature (Member/ Driver)
1. ______
2. ______
3. ______
- ______
- ______
- ______
- ______
- ______
- ______
- ______
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2017 Emerald Coast Electrathon Classic 120
DRIVER MEDICAL AUTHORIZATION, RELEASE, & LIABILITY WAIVER
You must read this form and sign it before participating in any Emerald Coast Electrathon events during the year 2017. If you are under the age of 18, you must also have a parent or legal guardian read and sign this form. To drive you must be at least 16 years old and have a valid driver’s license.
I, the undersigned, voluntarily agree to the following:
•The participant is participating in each Emerald Coast Electrathon event under their own free will, and the
Parent/guardian (if participant is under 18) approves of such participation.
•I am personally responsible for my actions, and I shall conduct myself with proper sportsmanship.
•I shall abide by the rules, conditions, guidelines, and decisions of Electrathon America and race/event officials.
I understand this is a non-professional program/event, and changes, delays, and/or errors may occur.
•I understand that the activities of the event are dangerous and involve risk; I accept the conditions under which
each of the events is held; and I accept and assume all risks inherent in each of these competition events,
including injury (fatal or otherwise) and property loss/damage, and including those that I may not foresee
or anticipate.
•I agree to assume all costs related to any medical treatment; I authorize my insurance company to pay benefits
for the costs of such treatment; I also authorize the disclosure of medical information to my insurance
company for the purpose of any claim;
•I understand each participant must provide her/his own medical insurance; I also understand that I am
responsible for any medical or other charges related to participation in the Emerald Coast Electrathon
event(s).
•I give my consent for medical treatment, and permission to event personnel to supervise or perform on-site
first- aid for minor injuries and to a licensed physician to hospitalize and secure proper treatment (including
Injections, anesthesia, surgery, or other reasonable and necessary procedures) for the participant (If you wish
to limit medical treatment, draw a line through it or add your comments.
•I hereby release, hold harmless, and agree to indemnify Gulf Power Company, Gulf Power Engineering
Society, Electrathon America, Board of Regents/State of Florida, State of Florida, track owner(s), event
sponsors, organizers, officials, volunteers, and other people and organizations or entities associated with the
event (RELEASEES) from any and all liability, whether injury is caused by my negligence, the negligence of
RELEASEES or the negligence of any third party, and agree to settle any and all disputes through established
event rules and procedures
I have read the entire Medical Authorization, Release, & Liability Waiver, I fully understand it, and I agree to be legally bound by it.
READ CAREFULLY BEFORE SIGNING.
THIS IS A RELEASE OF YOUR RIGHTS.
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Print name of Participant Participant’s signature Date
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If Participant is under 18 years of ageParent/legal guardian signatureDate
Print name of parent/legal guardian