2017 Membership Application for Kansas All-Terrain Vehicle Association
Name _________________________________________________________________ Age______Sex______
City __________________________________ State ______ Zip __________________
Phone _________________________ Email ______________________________________ Facebook __Y __N
VERY IMPORTANT Family Memberships will only include the names listed below:
By signing below, I have read the application and agree to all statements. I will comply with these requirements and understand that myself or my family will lose its access to Pomona area and void my/our membership if we fail to comply. Only KATVA members are allowed to ride at the Pomona ride area.
___ 90.00 (or $140.00) Single Membership (age 18 or older) includes all KATVA benefits.
___ $175.00 (or 240.00) Family Membership includes all KATVA benefits for parents and children residing at the same address and younger than 18 years of age.
The Pomona ride area is locked and a combination is needed to access the ride area. In order to receive the combination you MUST attend a club work day and pay the reduced membership dues or pay full membership dues.
CHOOSE ONE OF TWO OPTIONS BELOW:
___ I will attend a club workday. ___ I agree to pay full membership dues.
___ This is a new Membership ___ This is a renewal Membership # ____________
Paid by Check ________ Cash ________ ATV or AMA safety course? ____ Yes ____ No
I understand that all membership benefits become effective upon receipt of my membership card, except the right to participate in KATVA sanctioned events, which becomes effective immediately. KATVA benefits may change at any time by the KATVA Board of Directors. I understand that the KATVA does not assume liability for any aspects of my safety or that of my family. If I participate in any sanctioned event or ride on any KATVA property, owned or leased, I voluntary assess my ability, the track, course, facilities, conditions, and assume all risks therein. I also release & hold harmless the KATVA and/or its Board of Directors for any injury or loss to me or my property, or that of my family, which results therein.
_______________________________________________ _____________________Signature Date
If 2 adults are listed, each adult must initial all statements below:
_____ I understand that I am NOT allowed to let anyone ride at the Pomona Ride Area that is not a KATVA member.
_____ I understand that all members are required to wear a helmet while riding at Pomona Ride Area or KATVA events/activities.
_____ I understand long pants, over the ankle boots, and eye protection are also recommended while riding at the Pomona Ride Area or KATVA events/activities.
_____ I understand that double riding is NOT allowed at the Pomona Ride Area or at KATVA events/ activities unless the machine is manufactured as a 2 up vehicle.
_____ I will shut and lock all gates when I leave the Pomona Ride Area. I will not leave the main gate open when I am riding at the ride area.
_____ I will stay within all boundaries of the Pomona Riding Area and report any down fences.
_____ I will report the names of people that violate their agreement to the KATVA Board of Directors.
Mail to: KATVA, 5925 SW 58th St Topeka, KS 66619 (include waivers for all family members)
Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement for the Kansas All-Terrain Vehicle Association
IN CONSIDERATION of being permitted to participate in any way in the activities and of Kansas All-Terrain Vehicle Association (KATVA) and/or being permitted to enter upon, be present at, and the use of the KATVA Pomona Ride Area premises where all-terrain vehicles (ATV) or other motorized activities and events are being conducted (hereinafter referred to as the "Premises"), from the date hereof and for any and all dates thereafter, for any and all purposes and activities including, without limitation the operation, maintenance, observation or use of ATVs or other motorized vehicles or motorcycles (hereinafter collectively referred to as the "Activities"), the undersigned, on his/her own behalf (hereinafter referred to as the "Undersigned"):
1. Acknowledges, agrees, and represents that immediately upon entering the Premises the Undersigned shall and shall continuously thereafter, inspect every area of the Premises which the Undersigned enters, and the Undersigned further agrees and warrants that, if at any time, the Undersigned is in or about any part of the Premises and feels anything to be unsafe, the Undersigned will immediately advise a representative, employee, or agent of the owner of the Premises of such and if necessary will leave the Premises and/or refuse to participate in the Activities.
2. Hereby releases, waives, discharges and covenants not to sue (Department of the Army and the Kansas Department of Wildlife and Parks) the owner of the premises, any individual engaging in the Activities, rescue personnel (hereinafter referred to as Releasees"), from all liability to the Undersigned for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the Undersigned arising out of or related to the Premises or the Activities, whether caused by the negligence of the releasees or otherwise.
3. Hereby agrees to indemnify and save and hold harmless the releasees and each of them from any loss, liability, damage, or cost they may incur arising out of or related to the Premises or the Activities whether caused by the negligence of the releasees or otherwise.
4. Hereby assumes full responsibility for any risk of bodily injury, death or property damage arising out of, or related to the Premises or the Activities whether caused by the negligence of releasees or otherwise.
5. Hereby acknowledge that the activities are very dangerous and involve the risk of serious injury and/or death and/or property damage. The Undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releasees.
6. Hereby agrees that this Release and Waiver of Liability Assumption of the Risk and Indemnity Agreement extends to all acts of negligence by the releasees, including negligent rescue operations and is intended to be as broad and inclusive as is permitted by the laws of the State of Kansas.
I have read this Release and Waiver of Liability Assumption of Risk and Indemnity Agreement, fully understand that I have given up substantial rights by signing it, and have signed it freely and voluntarily without any inducement, assurance, or guarantee extent allowed by law.
_________________________________ _________________________________ Date_____________Signed Print Name Here
Parental Consent, Release and Waiver of Liability, Assumption of Risk, and Indem