Accident Waiver, Release Of Liability And Entry Form Park Ave Bike Weeknight Mtb Race printable pdf download

ACCIDENT WAIVER, RELEASE OF LIABILITY AND ENTRY FORM

Park Ave Bike Weeknight MTB Race

I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the potential

for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities,

temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to,

participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of

hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of

participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of

the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by

them or because of their possible liability without fault.

I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by

a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and

organizers, in which I may participate and that it will govern my actions and responsibilities at said events.

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors,

administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all

liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter

accrue to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS:

Netherlands Insurance CO

Alternative Sports, Inc, dba Park Ave Bike Shop

YMCA of Greater Rochester

Their directors, officers, employees, volunteers, representatives, and agents, the even holders, event sponsors, event volunteers;

(B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims

made as a result of participation in this event, whether cause by the negligence of releases or otherwise.

I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness

during this event.

I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film, likeness to

be used for any legitimate purpose by the event holders, producers, sponsors, organizers and assigns.

The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum

extent permissible under applicable law.

I hereby release Netherlands Insurance CO, Alternative Sports, Inc, dba Park Ave Bike Shop , YMCA of Greater

Rochester from all present and future claims resulting from negligence on the part Netherlands Insurance CO,

Alternative Sports, Inc, dba Park Ave Bike Shop, YMCA of Greater Rochester

I hereby certify that I have read this document; and, I understand its content.

______________________________ ______

_______________________________

__________

Print Participant’s Name

Age

Signature (If under 18 years old,

Date

Parent or guardian must also sign

PARENT OR GUARDIAN WAIVER FOR MINORS (Under 18 years old)

The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to

save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or

damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and

release said parties on behalf of the minor and the parents or legal guardian.

______________________________ ______

___________________________

__________

Print Participant’s Name

Age

Signature of Parent or Guardian

Date

Rider Name __________________________________ Race Category _______________________________

Team Name__________________________________ Racing Age as of 12/31/current year _______________

Whom to Notify in case of Emergency____________________________Phone Number____________________

For official use only!

Bib #___________________

Accident Waiver, Release Of Liability And Entry Form Park Ave Bike Weeknight Mtb Race

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