| Click to Print_Parental Consent Form for 4-state moto complex 2024.pdf |
Minors attending without their parents or legal guardian need to complete the attached form prior to arriving and bring the completed form with them to registration.
PARENTAL CONSENT FORM FOR MINORS
UNDER 18 YEARS OLD
FOR 4-STATE MOTO COMPLEX, NEOSHO, MISSOURI
NOTARY SIGNATURE ___________________________________________________________________________
NOTARY PUBLIC, COUNTY OF _________________________________________________________________
On this __________________ day of _____________________________, 2024
In the county of _______________________________________, State of _______________________________
The adult(s) ______________________________________________________________/
_________________________________________________________________
Being legal age, personally appeared before me to be the person whose name is here is subscribed.
THIS FORM MUST BE NOTARIZED TO BE A VALID DOCUMENT
You will need two (2) of these forms notarized, one for 4-State Moto Complex to keep, and one
for the Guardian/Authorized Adult to keep. Must be an ORIGINAL release; no photocopies will
be accepted.
PRINT CLEARLY USING BLACK OR BLUE INK
I/We - ____________________________________ & ____________________________________/ (_____)_______-___________
give my/our child permission for my/our child _______________________________________________________give ________________________________________________________
to compete in all motocross activities at 4-State Moto Complex on: _______________________________
through _______________________________.
I/We authorize _________________________________________/ (Guardian/Authorized Adult over age 18)
to act in my/our behalf as Guardian/Authorized Adult for my/our child so they he/she can sign
all Waiver & Release forms and seek medical attention if necessary.
(Father or Legal Guardian) (Mother or Legal Guardian) (Parent’s Phone #)
Signature of Parent __________________________________________________________ Date _____________________
Signature of Parent __________________________________________________________ Date _____________________
NOTARY TO COMPLETE THE FOLLOWING SECTION:
UNDER 18 YEARS OLD
FOR 4-STATE MOTO COMPLEX, NEOSHO, MISSOURI
NOTARY SIGNATURE ___________________________________________________________________________
NOTARY PUBLIC, COUNTY OF _________________________________________________________________
On this __________________ day of _____________________________, 2024
In the county of _______________________________________, State of _______________________________
The adult(s) ______________________________________________________________/
_________________________________________________________________
Being legal age, personally appeared before me to be the person whose name is here is subscribed.
THIS FORM MUST BE NOTARIZED TO BE A VALID DOCUMENT
You will need two (2) of these forms notarized, one for 4-State Moto Complex to keep, and one
for the Guardian/Authorized Adult to keep. Must be an ORIGINAL release; no photocopies will
be accepted.
PRINT CLEARLY USING BLACK OR BLUE INK
I/We - ____________________________________ & ____________________________________/ (_____)_______-___________
give my/our child permission for my/our child _______________________________________________________give ________________________________________________________
to compete in all motocross activities at 4-State Moto Complex on: _______________________________
through _______________________________.
I/We authorize _________________________________________/ (Guardian/Authorized Adult over age 18)
to act in my/our behalf as Guardian/Authorized Adult for my/our child so they he/she can sign
all Waiver & Release forms and seek medical attention if necessary.
(Father or Legal Guardian) (Mother or Legal Guardian) (Parent’s Phone #)
Signature of Parent __________________________________________________________ Date _____________________
Signature of Parent __________________________________________________________ Date _____________________
NOTARY TO COMPLETE THE FOLLOWING SECTION:
