“United Demolition Derbies”

PUTNAM COUNTY FAIR

Demolition Derby Entry Form/Figure 8 Racing

Figure 8 Racing/Truck Demo Derby/Lawn Mower Demo  Derby, June 22, 2012 @ 7pm

Car Demo Derby/Lawn Mower Demo Derby on Saturday, June 23, 2012 @ 7pm

 

Drivers under 18 years of age must provide signed and notarized form below.

 

NO ALCOHOL

Ohio Revised Code Chapters 4301, 4303 and 4399 prohibit the carry in or carry out of alcoholic beverages. This includes, but is not limited to all entertainment events and parking areas.

The Putnam County Fair will be offering Videos & Photos of this event.  If you would like to purchase a video or click on this link:  Video Purchase

                  

______  Check here for 80 & newer full size

______  Check  here for full size stock cars

______  Check  here for mini cars

______  Check  here for mini vans

______  Check  here for riding lawn mower

______  Check here for truck

______  Check here for Figure 8 racing

 

Driver’s Name:  _______________________________________________________        Date of Birth:  _________________________

 

Address:  ____________________________________________________________      Email Address:  _______________________

 

City / State / Zip: ______________________________________________________       Phone #:  ____________________________

 

I hereby expressly release both the producer and sponsor and all their associates for any injuries of any kind or nature which may occur or be received as  result of my participation in the 2012 Putnam County Fair Demolition Derby. I hereby expressly waive all claims for injury that may occur should I be injured while being a contestant in said contest.

 

 

If driver is under 18 years of age the following section MUST be signed by parent or guardian and NOTARIZED.

State of _________________  County of _________________________ I, __________________________________ being the parent

and or guardian of ________________________________________________ hereby consent to enter and  / or participate in the 2012

Putnam County Fair Demolition Derby and that said  ______________________________________________ is a minor and under

The age of 18, namely, age ____________, and that I hereby expressly release both the producer and sponsor and all their associates for any injury of any kind or nature, which may occur or be received as a result of said minor’s participation in said derby. I hereby expressly waive all claims for injury that may occur should said minor be injured while being a contestant in said contest.

 

Parent and / or Legal Guardian’s signature:  ________________________________________________________________________

 

Subscribed and sworn to this ____________ day of _______________________________________________________  AD 20____

 

Notary Public:  _________________________________________________ of _____________________________________ County

 

My commission expires:  _______________________________________________________________________________________

Entry Fees  “No Refunds on Entry Fees or Pit Passes”

Early Entry (No later than May 31)

______  Modified full size, stock class, mini cars,  mini vans, Figure 8 Racing                                 $40.00 (includes 2 pit passes)

______  Full size trucks                                                                                                                              $30.00 (includes 2 pit passes)

______  Riding lawn mowers                                                                                                                     $25.00 (includes 1 pit pass)

 

Late Entry (June 1 and after)

 ______  Modified full size, stock class, mini cars,  mini vans, Figure 8 Racing                               $50.00 (includes 2 pit passes)

 ______  Full size trucks                                                                                                                            $30.00 (includes 2 pit passes)

 ______  Riding lawn mowers                                                                                                                   $25.00 (includes 1 pit pass)

 

Payouts:

 Figure 8       1st $300       2nd $200      3rd $100

 Truck            1st $500       2nd $300      3rd $100

Lawn Mowers       1st $100      2nd $50                 

SPONSORED BY THE UNION BANK    

       

Mini cars      1st $150     2nd  $100      3rd $50 

Mini vans      1st $100                                             

        Stock cars    1st $150     2nd $100     $3rd $50         

                      80 newer       1st $1000     2nd $500     3rd $200                     

           Top 3 from each heat    $50     

SPONSORED BY FOX LIMA              

                

 

 

Must be at least 14 years of age to be in Pit Area

Make check payable to: Putnam County Fair.  Return entry fee with completed form to:

Putnam County Fair

P.O. Box 47  1490 E. Second Street

Ottawa, OH  45875

                                    Phone 419-523-4628                                      

Fax 419-523-9552

Web: http://www.putnamcountyfair.com/