2008 St. PATRICK'S DAY RIDE
ENTRY FORM
PLEASE PRINT
There is no pre-registration for this ride. If you like, you may print and complete this form before the ride to save time at registration. A separate entry form is required for each rider.
|
Last Name: |
First Name: |
|||
|
Street Address: |
||||
|
City: |
State: |
ZIP: |
||
| Home
Phone: We do not share this information. |
E-Mail: ( ) Send me info on future rides. |
|||
|
Emergency Contact Name: |
Emergency Phone # |
|||
Liability Waiver
In signing this waiver for myself, or as a parent or legal guardian for the
entrant named above, I hereby release from responsibility and hold harmless from
any claim, foreseen or unforeseen by me or my family, estate, heirs or assigns,
the Wheeling Wheelmen, Inc. ("Wheeling Wheelmen"), and it's agents,
employees, officers, volunteers, other participants, any sponsors, advertisers
and owners or lessors of the premises on which the St. Pat's Ride takes place
for any and all claims, damages, demands, injuries and losses whatsoever,
arising from my transportation to, participation in, and/or presence at the St.
Pat's Ride, and do so entirely of my own initiative. I understand that
riding a bicycle on a public street or road can be a risky and dangerous
activity and may result in serious bodily injury, including permanent
disability, paralysis and death (collectively "risks"). I fully accept
and assume all such risks and all responsibility for all costs, damages and
losses I incur as a result of my participation in the St. Pat's Ride. I agree to
obey all traffic laws and operate my bicycle in a safe manner. I certify that I
have read this waiver, fully understand it's terms, understand that I have given
up substantial rights by signing it and have signed it of my own free will and
accord. If the entrant is a minor, I, the minor's parent or legal guardian, understand
the nature of bicycling activities and the minor's experience and capabilities
and believe the minor to be qualified to participate in the St. Pat's Ride. I
also authorize emergency medical treatment if I or the above minor is injured.
| * Signature: | ** Age if under 18: |
| Printed name of Parent/Guardian: | Date: |
* Rider under 18 requires signature of parent or guardian.
** Rider 12 years or under must be accompanied by an adult
throughout the ride.