Consent Form

Declaration of consent for minors participating in the
AMG Customer Sports Championship 2015/2016
We, the parents or legal guardians (persons with parental responsibility pursuant to
section 1626 German Civil Code (BGB)), consent to our daughter / son
____________________________________________________________
Name of the daughter / son (please complete legibly in block letters)
participating in the 2015/2016 AMG Customer Sports Championship.
(1) We are aware that the AMG Customer Sports Championship is a competition
organized by Mercedes-AMG GmbH, for which all drivers and teams who race SLS AMG
GT3 vehicles in national and international motor races and/or racing series during the
classification period stated in the conditions of participation, are eligible.
(2) We confirm that we are aware that our daughter's/son's participation in the
2015/2016 AMG Customer Sports Championship presents dangers, and that driving in
the national and international motor races and/or race series detailed in the conditions
of participation carries with it the risk of serious injury and even fatal accidents.
(3) We have read the conditions of participation and have signed these ourselves, on
behalf of our daughter/son, by marking a cross in the confirmation box. We have
explained the conditions of participation to our daughter/son and indicated to her/him
the dangers and risks involved.
Mercedes-AMG · Limited Liability Company
Domicile: Affalterbach · Court of Registry: Stuttgart · Commercial Register No.: 310155
Board of Management: Tobias Moers (Chairman), Christian Wolff
A Daimler Company · USt-ID: DE811249798
SWIFT-BIC: DEUT DE SS 604 · IBAN: DE36 6047 0082 0083 9100 00
Mercedes-Benz and AMG – are registered trademarks of Daimler AG, Stuttgart, Germany
Mercedes-AMG GmbH
Daimlerstraße 1
71563 Affalterbach
Telefon +49(0)7144302
Telefax +49(0)7144302-120
www.mercedes-amg.com
(4) The signatories confirm that they have parental responsibility for the minor. If only
one of several persons with parental responsibility signs/has signed this declaration of
consent and the conditions of participation, this signatory assures that the other person
with parental responsibility is aware of this declaration and the conditions of
participation, agrees to the content therein and has authorized the signatory to give this
declaration and to sign the conditions of participation for the minor on behalf of the
other person with parental responsibility. The signatories are liable to Mercedes-AMG
GmbH for the correctness of the aforementioned declarations.
(5) This declaration of consent is governed exclusively by German substantive law
(including, but not limited to, the provisions of the German Civil Code) excluding any
conflict of law’s provisions.
The authoritative language for this declaration of consent is German. The German
version alone will be authoritative, even if the declaration is translated into another
language. Whether the original German version of the declaration of consent should be
translated is solely a matter for the signatories. If Mercedes-AMG GmbH provides the
signatories with a translation, it is without any legal obligation and – except in cases of
intent – is subject to the exclusion of any warranty or any contractual or noncontractual liability on the part of Mercedes-AMG GmbH.
Mercedes-AMG · Gesellschaft mit beschränkter Haftung
Sitz: Affalterbach · Registergericht: Amtsgericht Stuttgart · HRB-Nr.: 310155
Geschäftsführung: Tobias Moers (Vorsitzender), Christian Wolff
Ein Unternehmen der Daimler AG · USt-ID: DE811249798
SWIFT-BIC: DEUT DE SS 604 · IBAN: DE36 6047 0082 0083 9100 00
Mercedes-Benz und AMG – sind eingetragene Marken der Daimler AG, Stuttgart, Deutschland
Mercedes-AMG GmbH
Daimlerstraße 1
71563 Affalterbach
Telefon +49(0)7144302
Telefax +49(0)7144302-120
www.mercedes-amg.com
The place of jurisdiction for all contractual claims arising out of this declaration and for
all non-contractual claims is Affalterbach (registered office of Mercedes-AMG GmbH) if
one of the signatories has no general place of jurisdiction in Germany, moves his/her
domicile or place of habitual residence abroad after conclusion of the declaration, or if
his/her domicile or place of habitual residence is unknown at the time the action is
filed.
______________________________________________________________
Place, date, signature of the parent(s) or legal guardian(s)
______________________________________________________________
Name of the parent(s) (please complete legibly in block letters)
Mercedes-AMG · Gesellschaft mit beschränkter Haftung
Sitz: Affalterbach · Registergericht: Amtsgericht Stuttgart · HRB-Nr.: 310155
Geschäftsführung: Tobias Moers (Vorsitzender), Christian Wolff
Ein Unternehmen der Daimler AG · USt-ID: DE811249798
SWIFT-BIC: DEUT DE SS 604 · IBAN: DE36 6047 0082 0083 9100 00
Mercedes-Benz und AMG – sind eingetragene Marken der Daimler AG, Stuttgart, Deutschland
Mercedes-AMG GmbH
Daimlerstraße 1
71563 Affalterbach
Telefon +49(0)7144302
Telefax +49(0)7144302-120
www.mercedes-amg.com