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  • MINERAL COUNTY RECREATION & COMMUNITY DEVELOPMENT
    DEPARTMENT
    PO Box 2281, Hawthorne, Nevada 89415
    (775) 481-5925 kisom@mineralcountynv.org
    (775) 316-2188 jsanchez@mineralcountynv.org

  • Mineral County Demolition Derby Participant Application and Liability Release

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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • A non-refundable fee of $100.00 must accompany this signed and witnessed application
    Return this Application to the MCRCD office no later than two weeks prior to the event.
    The applicant has read and understands all rules and requirements associated with this event, including post event vehide removal requirements
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          Mini
          $100.00
            
          Stock
          $100.00
            
          Truck


          $100.00
            
          Total
          $0.00

          Credit Card

        • AGREEMENT

        • I, Participant, understand that participation in a demolition derby is inherently dangerous and involves significant risks, including but not limited to: Vehicle collisions, Mechanical failure, Fire or explosion, Flying debris, Bodily injury, permanent disability, paralysis, or death, Damage to personal property. I knowingly and freely assume all risks, both known and unknown, even if arising from the negligence of the Released Parties (defined below), and assume full responsibility for my participation. In consideration of being permitted to participate, I hereby release, waive, discharge, and covenant not to sue: Mineral County, Sponsors, Event Staff, or Volunteers (collectively referred to as "Released Parties") from any and all liability, claims, demands, losses, or damages arising out of or related to any injury, disability, death, or property damage, whether caused by negligence or otherwise. I agree to indemnify and hold harmless the Released Parties from any claims brought against them by or on behalf of me or any third party arising out of my participation. I authorize emergency medical treatment if necessary and accept full responsibility for any associated costs. I certify that my vehicle meets all event safety requirements. I am solely responsible for the mechanical condition of my vehicle. I have inspected my vehicle and equipment prior to competition. I agree to wear all required safety gear. Failure to comply may result in disqualification. I certify that I am physically and mentally fit to participate and am not under the influence of drugs or alcohol. I grant permission to Mineral County to use photographs or video of me taken during the event for promotional purposes.

        • If the participant is under 18, a parent or legal guardian must also sign below agreeing to all terms.
        • Acknowledgment of Understanding

        • I have read this Release and Waiver of Liability Agreement fully, understand its terms, and sign it freely and voluntarily. It the consideration of being able to participate in the DEMOLITION DERBY, on May 16th 2026, the undersigned agrees to read and observe all the rules and safety requirements set forth by the drivers and sponsors of the derby. I, the undersigned, hereby state that I am familiar with and assume all risks incidental to my participation in said DEMOLITION DERBY.
        • MINOR DRIVER RELEASE - DRIVER UNDER EIGHTEEN (18) YEARS OF AGE NO DRIVERS OR PIT ENTRY TO ANYONE UNDER 16 YEARS OF AGE
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        • Should be Empty: