Demo Derby Application

Name *
Age *
Phone *
Email *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Check Entry Class:
Rear Wheel DriveFront Wheel DriveMini VanSUV
Vehicle Number Requested: (Please Note: This does not guarantee that you will get this number. All drivers will be contacted via the information provided above by a derby organizer/volunteer prior to the derby to confirm your number) *
Number of members in Pit Crew (maximum 2) *
Demolition Derby Contract with Release and Waiver The undersigned is aware of the risks and liabilities associated my participation in the Demolition Derby and hereby waive and absolve the Woodstock Old Home Week Agriculture Exhibition Inc., its Board of Directors, Demolition Derby Organization Committee and Sponsors for any and all liability relating to my participation in this event. I have read the rules and agree to abide by them. I have read and fully understand the rules and agree to follow them 100%. I accept the decisions of the Judges as final.
Signature *
Date *
Fees: Car & Driver- $30.00 Pit Crew: $5.00 Each (Maximum of 2)
**Please send all fees (cheque or money order) and entry form by July 26, 2019
**Make cheque or money order payable to Woodstock Old Home Week
Questions??? Call or Text: 328-5222 or Email: [email protected] Mail Entries to: Woodstock Old Home Week Demo Derby 103 Connell Park Road Woodstock, NB E7M 1M5