SKK - Shasta SuperMoto

Kart Klub Practice & Waiver Registration Form

Use this form to register for Kart participating in SuperMoto practice day. This registration allows up to 2 adults and 6 minor participants from the same household to complete the required waiver and submit practice fees online.

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Who Is Practicing Today? *

Adult (s)
Adult & Minor (s)
Only Minor (s)

How Many Adults Practicing?

Responsible Party Information *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

List all karts make/model, engine size and plate #’s used during practice *

Have You Read Shasta SuperMoto's Assumption of Risk and Waiver Agreement *

📄 Read Waiver

Electronic Waiver Signature *

Clear Signature

WAIVER SIGNATURE By signing above, I certify that I have read, understand, and agree to the Shasta SuperMoto Release and Waiver of Liability, Assumption of Risk, Medical Authorization, Media Release and Indemnity Agreement. I understand that my electronic signature has the same legal force and effect as my handwritten signature.

Adult Driver #2 Information *

First

Last

Adult Driver #2 Date of Birth *

Adult Driver #2 Email *

Adult Driver #2 Phone *

Adult Driver #2 List all karts make/model, engine size and plate #’s used during practice *

Adult Driver #2 , Have You Read Shasta SuperMoto's Assumption of Risk and Waiver Agreement *

📄 Read Waiver

Adult and

Adult Driver #2 Electronic Waiver Signature *

Clear Signature

How Many Minors Practicing? *

Minor Information *

First

Last

Minor Date of Birth

Minor List all karts make/model, engine size and plate #’s used during practice *

Minor #2 Information *

First

Last

Minor #2 Date of Birth

Minor #2 List all karts make/model, engine size and plate #’s used during practice *

Minor #3 Information *

First

Last

Minor #3 Date of Birth

Minor #3 List all karts make/model, engine size and plate #’s used during practice *

Minor #4 Information *

First

Last

Minor #4 Date of Birth

Minor #4 List all karts make/model, engine size and plate #’s used during practice *

Minor #5 Information *

First

Last

Minor #5 Date of Birth

Minor #5 List all karts make/model, engine size and plate #’s used during practice *

Minor #6 Information *

First

Last

Minor #6 Date of Birth

Minor #6 List all karts make/model, engine size and plate #’s used during practice *

Emergency Contact Information *

First

Last

Emergency Contact Phone *

Parent/Guardian Electronic Waiver Signature *

Clear Signature

PARENT / LEGAL GUARDIAN WAIVER SIGNATURE By signing above, I certify that I am the parent or legal guardian of the minor applicant, have authority to sign on the minor’s behalf, and agree to the Shasta SuperMoto Release and Waiver of Liability, Assumption of Risk, Medical Authorization, Media Release and Indemnity Agreement. I understand that my electronic signature has the same legal force and effect as my handwritten signature.

Electronic Signature Consent *

I consent to the use of my electronic signature and understand that it has the same legal force and effect as an original handwritten signature.