Kids Power Wheels Obstacle Course
June 24th at 4:30pm Triangle Museum Grounds
Rules, Entry and Waiver Form 2017
This is a fun class for ages 4 to 7. Prizes for all participants. ALL children MUST be accompanied by a
parent or guardian. NO EXCEPTIONS. Parent or guardian must purchase a $20 day Pass and must sign a
release waiver form before child will be allowed to participate. Entry fee for each power wheels
contestant is $5.
All participants can pre-register or register on Saturday June 24th before 4pm
Pre-registrations: Please send the entry form to [email protected] mark “Power Wheels” in the
subject line or send by mail to: Roeby de Voogd vd Straten, Box 3428, High Prairie, AB, T0G 1E0
Event Rules:
• Kids 4-7 years of age may participate.
• All children must be signed in with one parent or guardian at the derby gates.
• All children must wear approved safety helmets. Bicycle or hockey helmets are acceptable.
• Shoes or sneakers required. NO sandals.
• No passengers.
• Must be a Power Wheel that can be sat in not on. Keep in mind that they may be running into each
other. No 4 wheelers, motorcycles or tractor models will be allowed to race.
Power Wheel Build:
• Stock tires only. No screws in tires, no chains, etc.
Tires may be covered in duct tape to prevent them from breaking.
• Limited to 12 volt batteries only.
• No added reinforcements for strength.
• Trunk, hood and doors should be secured with tape, rope (or other flexible products)
so they do not fly open or off during derby.
• Do NOT raise or lower. They must be the stock height that came from the store.
• Please remember this is for the kids! If there are modifications that are made that should not have
been, your child will not be able to run, and will be very disappointed.
Power Wheel Decorations:
• Decorative changes can be made to the Power Wheels to make it look like a derby car, however, there
can be no reinforcement to the Power Wheels. Changes and additions can ONLY be decorative.
(Header pipes sticking up, painting the car, etc.)
• Each power wheel must have a number on one side for scoring.
Power Wheel Event:
• One Parent/Guardian will be allowed on the track with their child during the event.
• All power wheels will be checked in before 4pm at the information Booth, and then impounded until
time for the event.
• There will be a safe zone waiting area provided. NO CHILDREN UNDER THE AGE OF 16 ALLOWED IN THE
PITS.
• Immediately after the class, the Power Wheels will be moved to the safe zone waiting area. Children
and parents must return to the grandstand bleachers for the derby.
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Power Wheels Entry 2017
PARENTS NAME: ________________________________________________________
CHILD’S NAME: _________________________________________________________
DATE OF BIRTH: ___________________ AGE: ______Power Wheel #:______________
PHONE: ____________________________ E-MAIL: ____________________________
ADDRESS: ________________________CITY: ________________STATE: __ ZIP: _____
Power Wheels Waiver Form 2017
Insurance Release:
I, as parent or guardian of the above named contestant, hereby release any and all sponsors, the Pioneer
Threshermans Association, its’ members and volunteers, or anyone else associated with the above in an
official capacity, of any liability in the event of an accident to the above named contestant in this children’s
event.
Signature of Parent or Guardian: ______________________ Date: ____________________________
Acknowledgement of Risk: The undersigned acknowledged that obstacle courses are dangerous activities
and that the participation in this event, exposes the participant to a substantial and serious risk of property
damage, personal injury.
Release of Sponsor: The undersigned, being fully aware that participation in the demolition derby will
expose him/her to a substantial and serious risk of property damage and/or personal injury or death,
hereby releases any and all sponsors from the liability for any and all property damage, personal injuries or
other claims arising from the undersigned participation in the demolition derby including those that are
known and unknown, foreseen and unforeseen, future and contingent.
This release has been carefully and fully read by the undersigned and the undersigned fully understands its
terms and conditions.
Note: Since participants are under 18 years of age, their parent or guardian must give their consent as
follow:
Consent of Parent or Legal Guardian:
I, ____________________________________ have read the above release in full. I fully understand its
terms and conditions and I hereby voluntarily execute and deliver this consent to the participation in the
derby. I further agree to be fully bound by the release’s terms and conditions in both my individual capacity
as parent or legal guardian for the undersigned.
Signature:_____________________________ Date __________
The Pioneer Threshermans Association reserves the right to alter, amend, add, delete, or modify these rules at any time without
prior notice. More info 780 523 4010
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