The Ridge, LLC

P.O. Box 256, Springville, AL 35146
 CUSTOMER INFO
 RIDE DATE           VEHICLE DRIVEN (CIRCLE):

ATV

   DIRTBIKE
 NAME           DATE OF BIRTH:      
 ADDRESS          

DRIVERS LICENSE #:

      
 CITY  

STATE

  

ZIP

          
 PHONE                  
 EMAIL                  

EMERGENCY CONTACT

         

ARRIVAL TIME:

      
(name/phone)      
                   

CHECK BELOW

            

CUSTOMER INITIALS
q

I authorize the release of any and all medical records for the following person(s) listed on this form, in the event of an injury while on the property of The Ridge LLC

 F______
q

I have read, understand and agree to all Riding Rules and Regulations.

 F______
q

I have read, understand and agree to the Indemnity and Hold Harmless Agreement.

 F______
q

I understand that The Ridge, LLC does not cover any person(s), machinery, vehicles, personal property, etc. with any type of insurance.

 F______
  LIST ALL RIDERS AND NON-RIDERS IN YOUR FAMILY/GROUP      
                   
AGE

NAME (PRINT) 

SIGNATURE (OR GUARDIAN)

OFFICE USE
   

û

  
    û  
    û  
    û  
    û  
                   
OFFICE USE                  
PAYMENT TYPE CASH CHECK          
                   

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