Accident Waiver & Release of Liability Race Registration Form
This form must be read carefully, filled out completely and signed by each racer.
Appalachian Classic Youth Series
June 16, 2007 3 p.m.
NO RACE FEE
Name:__________________________________________ Age:___________ DOB: ___________
PO Box or Street: ____________________________________________________________________
City:________________________________________ State:________ Zip: ________________
Phone # : ____________________________________________
Emergency Contact Name:____________________________________ Phone: ________________
E-mail address: ______________________________________________________________________
6 years and under 7 and 8 years 9 and 10 years 11 and 12 years
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, event monitors, producers of the event and lack of hydration. These risks are not only inherent to athletes, but are also present for volunteers. I hereby agree to 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 property owned, maintained or controlled by them or because of their liability without fault.
I certify that I am physically fit, have trained sufficiently for participating in this event and have not been advised otherwise by a qualified medical person.
I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by 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: The West Virginia Mountain Bike Association, affiliated organizations and any involved municipalities, their directors, officers, employees, volunteers, representatives or agents, the event holders, event directors, event sponsors, event volunteers, property owners: (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 caused by the negligence of releases or otherwise.
I hereby consent to receive medical treatment, which 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, organizers and/or assigns.
This Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum permissible under applicable law.
I further agree to abide by all the rules and regulations as set forth by the director of this event.
I hereby certify that I have read this document and I understand all its contents.
Entrants Signature: ________________________________________________ Date: _________
(Note: If entrant is age 17 or under, Signature of Parent or Guardian is required below) The undersigned parent and natural or legal guardian does hereby represent that he/she is, in fact, acting is such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, 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.
Signature of Parent or Guardian: ____________________________________________ Date: ___________
YOUTH SERIES RELEASE FORM
_____________________________________________ ______________________________________
Entrant's First Name Last Name
___________________________________________________________________________________________
Street Address
_________________________________ _______ ________________
City State Zip Code
Age: _______________ Gender: [ ] Male [ ] Female Race #: ______________
STANDARD ATHLETE'S RELEASE FORM
NOTICE: THIS ENTRY BLANK AND RELEASE FORM IS A CONTRACT WITH LEGAL CONSEQUENCES. READ IT CAREFULLY BEFORE SIGNING.
I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT I AM RELEASING THE APPALACHIAN CLASSIC AND ITS AGENTS, EMPLOYEES, MEMBERS, SPONSORS, PROMOTERS AND AFFILIATES (COLLECTIVELY "RELEASEES") FROM LIABILITY.
The undersigned, on behalf of the above-named minor, a prospective entrant in this Youth Series event, hereby represents that he or she is fully entitled and authorized, as parent or legal guardian of entrant, to sign this RELEASE FORM for this event. As a condition of the acceptance of my application for entry in the above event, and as an express term of this agreement, I agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all losses, claims, actions, causes of action, or proceedings of any kind which may be initiated by the entrant or by any other person or organization on the entrant's behalf, including demands for damages, judgments, costs, loss of services, or expenses, arising from the activities contemplated by this agreement, including but not limited to reasonable attorney fees incurred by Releasees and INCLUDING THE RISK OF ANY NEGLIGENCE OF RELEASEES. The undersigned further states, to his or her knowledge, that entrant has no physical or mental condition which would endanger entrant or others or interfere with entrant's ability to participate in this event.
In consideration of entering this race, in signing this Agreement as parent and/or guardian of entrant, on behalf of entrant and myself, I freely, voluntarily and expressly agree to the following:
1. I understand that athletic cycling competition is dangerous and involves INHERENT RISKS OF PROPERTY DAMAGE, INJURY OR DEATH. I hereby agree to freely, voluntarily and expressly ASSUME AND ACCEPT ANY AND ALL RISK associated with participation in this event, including but not limited to: the danger of collision with pedestrians, vehicles, other racers, fixed or moving objects; dangers arising from surface hazards, equipment failure, inadequate safety equipment, conditions stemming from weather effects; and the possibility of serious physical and/or mental trauma or injury associated with athletic cycling competition;
2. To accept FULL RESPONSIBILITY for entrant's safety precautions and awareness, including but not limited to: familiarity with the race course, the National Offroad Bicycle Association rules, any special regulations for this event; an understanding and awareness that situations may arise during the race which may be beyond the control of the race officials or organizers; and the the entrant is required to continually ride in a manner that will neither endanger him/herself or others. Also, entrant and parent or legal guardian are responsible for the condition and adequacy of the entrant's competition and safety equipment, including his or her helmet, which must meet/exceed the National Offroad Bicycle Association rules for protection from serious head injury;
3. To authorize and consent to the entrant's likeness being used in advertising or promotional materials; and
4. To RELEASE, for entrant, myself, and all heirs, executors, administrators, representatives, assigns and successors, ANY AND ALL RIGHTS AND/OR CLAIMS AND FUTURE RIGHTS AND/OR CLAIMS against the sponsors of this event, the promoter and/or any promoting organization(s), property owners, law enforcement agencies, public entities, special districts and their respective agents, officials, employees or representatives, for ANY DAMAGES which may be sustained by entrant and/or myself, directly or indirectly, arising out of entrant's participation in or association with the event or travel to or from the event. I PROMISE NOT TO SUE RELEASEES on my behalf or on the behalf of my Child regarding any claim arising from my Child's participation in the Race.
Parent or guardian further agree that this RELEASE cannot be modified unless such modification is in writing and signed by authorized representatives of both parties, and that if there is a waiver of any section or a finding that any section of this Agreement is invalid, the remainder of this RELEASE shall remain valid and in effect.
My signature below is evidence of my understanding of and agreement to the above stated terms.
Date: _______________________ Signature: ________________________________________________________
7/16/2004