ENROLLMENT/CLAIM FORM
(PAGE ONE)
In consideration of being permitted to participate in the Suzuki Good Scholar Program ("Program"), I (PRINT NAME) __________________________,
for myself, my successors, heirs, and assigns, release and forever discharge American Suzuki Motor Corporation ("ASMC") and its parent company, affiliates,
agents, employees, servants, officers, and directors, and authorized Suzuki dealers ("related parties"), from all claims, actions, or judgments I may have or
claim to have against ASMC and related parties. I agree that I am responsible for all personal injuries, including death, and injuries to property, real or personal,
caused by or arising out of my participation in the Program.
I further agree for myself, my successors, heirs, and assigns to indemnify and hold ASMC and related parties harmless from all claims and suits for personal
injuries, including death, and damages to property caused by my act or omission, or arising out of or in any way relating to my participation in the Program,
and from all judgements recovered and from all expenses incurred in defending such claims or suits.
I further agree that my name, as well as any photographs, pictures, slides, movies or any other recording, image or likeness of me or made in connection with
my participation in the Program, or any reproduction of the same, may in any manner be used by ASMC, or by any person, corporation, or association
authorized by ASMC without compensation.
I understand that Section 1542 of the California Civil Code provides that a general release does not extend to claims which I do not know or suspect to exist in
my favor at the time of signing the release, which if I knew or suspected such claims, would have materially affected my willingness to sign the release.
I HEREBY WAIVE MY RIGHTS under Section 1542 of the California Civil Code and any similar law of any other state, and I acknowledge that this waiver is
an essential term of the General Release without which I would not have signed this General Release.
Applicant's signature, or signature of parent or guardian if applicant is under 18 years of age:
Signature___________________________________________________________________________________________
I understand that I must be the registered owner of a Suzuki RM65, RM85, RM85L, RM125, RM-Z250 or RM250 motorcycle purchased from an authorized Suzuki
dealer, with a model year corresponding to the school year for which I am seeking the award; that I must race in at least five organized motocross races during the
school year corresponding to the model year of my Suzuki motorcycle; and that I must be a full time student and maintain a "B", 3.0, or 80% Grade Point Average
(GPA) for the school year to qualify for the Program and receive an award. The Good Scholar award form must be postmarked by July 31 of the year for which I
am seeking the award in order for me to be eligible for participation.
I have read and understand the foregoing release and agree to all of its terms.
Signature of Applicant_________________________________________________________________ Date________________
Signature of Parent or Guardian___________________________________________________________ Date________________
Applicant's Social Security Number_____________-__________-_____________ E-Mail Address______________________________
Applicant's Name (PRINT)_______________________________ Age_____Date of Birth_________ Phone #(______)______________
Street Address______________________________ Apt. #_____ City_____________________________State____ Zip_________
Address of Parent or Guardian, if different:
Street Address______________________________ Apt. #_____ City_____________________________State____ Zip_________
PLEASE TURN OVER TO COMPLETE APPLICATION
GOOD SCHOLAR AWARD
