Official Entry Form

6th Annual Walmart ISD & CMNH

Cars, Bikes, and BBQ

All proceeds benefitting Childrens Miracle Network Hospitals

Saturday, May 9, 2015, 9a - 3p Walmart Home Office Melvin Ford Parking Lot 720 SW 8th Street, Bentonville AR
Return completed forms to: ACHcarshow@walmart.com or
Walmart ISD ATTN: Steve Evans, 805 SE Moberly Lane, Bentonville, AR 72716-0560

1. Contact Info
Name:
Mailing Address:
City/State:
Car Club Affiliation:
Phone:
Email:
Emergency Contact:
Vehicle Year/Make/Model:
Vehicle Mods:

2. Judging Class

Please fill out all information below:

Registration Form#:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(H)______________________________ (C) ________________________________
______________________________________________________________________
________________________________ (P)________________________________
______________________________________________________________________
______________________________________________________________________

Please select your judging class (choose only one per vehicle):

Original: only stock/OEM factory components

Modified: non-stock/after-market items added to car

Cars
Original Modified
1900 -1970
1900 -1970
1971- present
1971- present
Trucks
Original Modified
1900 -1970
1900 -1970
1971- present
1971- present
4x4
Foreign
1900 - 1980
1981- present

Mothers Only Car/Truck/SUV

Mopar
Camaro
Corvette
Mustang
Pontiac
Motorcycles
Metric Touring
Metric Cruiser
American Touring
American Cruiser
Sport Bike
Custom Paint Class
Mothers Only

*Vote for People's Choice awards by purchasing donation tickets. There's no limit on the number
of votes you can cast, what vehicle you can vote for, and you can even vote for your own ride!

3. Fees/Donations

Event Coordinator Use Only

Schedule of Events
(Subject to change)

7 a.m.

Philanthropy Partner
Booth Setup

8:30 - 10 a.m.

Registered Vehicle
Setup

10 a.m.

Judging Begins

10a - 2 p.m.

Car & Bike Show

1 p.m.

Judging Concludes

10a - 1 p.m.

Silent Auction Bidding

2 - 2:30p.m.

Silent Auction Winners

Announced

2:30 - 4p.m.

Awards

4 - 6 p.m.

Clean-up/Tear-down

All event proceeds benefit Childrens Miracle Network Hospitals

Registration fees can be paid along with required waiver signed in person the day of the show at the Registration
Booth. Only cash or check will be accepted. All checks should be made payable to: Wal-Mart Stores, Inc.
$20 Pre-registration (Completed Entry Form must be received before Monday, May 4, 2015)
$25 Day-of-Show Registration
In addition to the registration fee, I would like to donate $_________ additional dollars to CMNH.

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Official Entry Form

6th Annual Walmart ISD & CMNH

Cars, Bikes, and BBQ

All proceeds benefitting Childrens Miracle Network Hospitals

4. Sign and Date

Please read information below carefully, then initial, date, and sign:

RELEASE AND WAIVER OF LIABILITY,

ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
IN CONSIDERATION of being permitted to compete, officiate, observe, work for, or participate in any way in Walmart ISDs
Childrens Miracle Network Hospitals (CMNH) Car, Bikes, and BBQ event or activities (EVENT), or being permitted to enter
for any purpose any RESTRICTED AREA thereof (defined as any area requiring special authorization, credentials, or
permission to enter or any area to which admission by the general public is restricted or prohibited), I, for myself, my
personal representatives, heirs and next of kin:

1. Hereby RELEASE, WAIVE, and DISCHARGE Walmart, CMNH, the promoters, participants, car club associations,
sanctioning organizations or any affiliate, subsidiary or subdivision thereof, judges, car owners, rescue
personnel, sponsors, vendors, advertisers, owners and lessees of premises used to conduct the EVENTS, all
for the purposes herein referred to as RELEASEES, FROM ALL LIABILITY TO ME, my personal representatives,
assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS
THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN THE DEATH OF
THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENTS, WHETHER CAUSED BY THE
NEGLIGENCE OF THE RELEASEES OR OTHERWISE. In addition, I COVENANT NOT TO SUE any of the RELEASEES
based upon any claim arising out of any of the EVENTS.
2. Hereby ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE
arising out of or related to the EVENTS whether caused by the NEGLIGENCE OF RELEASEES or otherwise.
3. Hereby AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the RELEASEES and each of them from
any loss, liability, damage, or cost they may incur due to claims brought against the RELEASEES arising out
of my injury, or death, or damage to my property while I am preparing, competing, practicing, observing
or working for or for any purpose participating in the EVENT and whether caused by the negligence of the
RELEASEES or otherwise.
4. Hereby agree that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all
acts of negligence by the RELEASEES, INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad
and inclusive as is permitted by the laws of the State of Arkansas and that if any portion thereof is held invalid,
it is agreed that the balance shall, not withstanding, continue in full legal force and effect.
5. Hereby agree that I will not bring onto and/or consume any alcoholic beverages at or on the EVENT premises.
6. Hereby understand that by registering and participating in the EVENT I am not guaranteed any compensation,
prize, title, or award and that all judging decisions are final.
7. Hereby perpetually and irrevocably give RELEASEES and its affiliates my consent and authorization to use my
likeness in any medium and for any purpose whatsoever. I irrevocably release, discharge, and hold harmless
RELEASEES from any claims, demands, or causes of action that I may now have or may hereafter have for
defamation, slander, libel, invasion of privacy or right of publicity, copyright infringement, or any other right
arising out of or relating to the use of my likeness.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT,
FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP RIGHTS BY SIGNING IT, AND HAVE SIGNED IT
FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND
MY SIGNATURETO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Signature:
Printed Name:

__________________________________ Date:
______________
__________________________________

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