Galesburg Motorcycle Club, Inc.
Minor Release Form

District 17 Guardian Release Transfer Form

    Permission for Minor to Race with non-parent guardian

(Must be Notarized)

I, ____________________________________ give my minor Child,

______________________________________ permission to participate at the races held

at the GALESBURG MOTORCYCLE CLUB, INC. on _______________(Date of Event).

I have named this adult, _____________________________________ to act as guardian

    of the day for this event. (Good only for this day.)    Date:__________________

 Father's Signature:___________________________________________

 Mother's Signature:__________________________________________

 Signed before me on this ___________ day of _____________  20_____

Notary Signature _____________________________________________

My Commission expires:________________________________________