Tour
DeCuse
Bringing cycling, hope and vision to inner city youth
OUR
FUNDRAISING GOAL IS FOR EACH
CYCLIST TO RAISE A MINIMUM OF $100.
MAKE A DIFFERENCE, IMPROVE A CHILD’S LIFE!
PLEASE COMPLETE THE FOLLOWING INFORMATION
TODAY’S DATE
________________________________
EVENT NAME 8
hours of b.i.k.e.-Syracuse 2009
EVENT DATE ____June 21, 2009_________________
ACTIVITY ENTERED ____________________________
CLUB/TEAM NAME ______________________________
NUMBER OF RIDERS _______
NAME
________________________________________
RACING AGE (as of Dec. 31, 2008) ________________
ADDRESS _____________________________________ R
# ____________ (office use)
CITY
EMERGENCY CONTACT __________________________
EMERGENCY CONTACT PHONE ____________________________
I ACKNOWLEDGE THAT BY
SIGNING THIS DOCUMENT, I AM ASSUMING RISKS AND AGREEING TO IMDEMNIFY NOT TO SUE
AND RELEASE FROM LIABILITY THE ORGANIZER OF THIS EVENT, b.i.k.e.-SYRACUSE, AND
THEIR RESPECTIVE AGENTS, EMPLOYEES, VOLUNTEERS, MEMBERS, CLUBS, SPONSORS,
PROMOTERS AND AFFILIATES (COLLECTIVELY “RELEASEES”).
AND THAT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS.
THIS ENTRY BLANK AND RELEASE IS A CONTRACT WITH LEGAL AND BINDING
CONSEQUENCES AND IT APPLIES TO ALL RACES AND ACTIVITIES ENTERED AT THE EVENT
REGARDLESS WHETHER OR NOT LISTED ABOVE. I
HAVE READ IT CAREFULLY BEFORE SIGNING AND I UNDERSTAND WHAT IT MEANS AND WHAT I
AM AGREEING TO BY SIGNING.
In
consideration of the issuance of a license to me by one or more Releasees or the
acceptance of my application for entry in the above event, I hereby freely agree
to make the following contractual represent- ations and agreements.
I ACKNOWLEDGE THAT CYCLING IS
AN INHEREENTLY DANGEROUS SPORT AND FULLY REALIZE THE DANGERS OF PARTICIPATING IN
THIS EVENT, whether as a rider, official, coach, mechanic, or otherwise,
and FULLY ASSUME THE RISK ASSOCIATED WITH SUCH PARTICIPATION INCLUDING,
by way of example and not limitation: dangers associated with
man made and natural jumps; the danger of collision with pedestrians,
vehicles, other riders, and fixed and moving objects; the dangers arising from
surface hazards, including pot holes, equipment failure, inadequate safety
equipment; use of equipment provided by the event organizer and others, THE
RELEASEE’S OWN NEGLIGENCE, the negligence of others and weather
conditions; and the possibility of serious physical and/or mental trauma or
injury, or death associated with the event.
For myself, my heirs; executors, administrators; legal representative,
assignees, and successors in interest (collectively “Successors”).
I HEARBY WAIVE, RELEASE,
DISCHARGE, HOLD HARMLESS, AND PROMISE TO IMDEMNIFY AND NOT TO SUE the
releasees and all sponsors, organizers and promoting organizations, property
owners, law enforcement agencies, public entities, special districts and
properties that are in any manner connected with this event, and their
respective agents, officials and their employees through or by which the event
will be held, (the foregoing are also respectively deemed to be Releases), FROM
ANY AND ALL RIGHTS AND CLAIMS ARISING
FROM THE RELEASEES OWN NEGLIGENCE, which I have or which hereafter may
accrue to me and from any and all
damages which may be sustained by me directly or indirectly in connection with,
or arising out of my participation
in or association with the event, or travel to or return from the event.
I agree it is my sole responsibility to be familiar with the event course
and agenda, the Releasee’s rules, and any special regulations for the event
and agree to comply with all such rules and regulations.
I understand and agree that situations may arise during the event which
may be beyond the control of the Releasees, and I must continually ride and
otherwise participate so as to neither endanger myself nor others.
I accept responsibility for the condition and adequacy of my equipment,
and equipment provided for my use, and my conduct in connection with a
b.i.k.e.-Syracuse event. I will wear
a helmet which satisfies the requirements of the Releasees’ Racing Rules or
Regulations and that can protect against serious head injury, and assume all
responsibility and liability for the selection of such a helmet.
I have no physical or medical condition which would endanger my self or
others if I participate in this event, or would interfere with my ability to
safely participate in this event.
I
agree, for myself and my successors, that the above representations are
contractually binding, and are not mere recitals, and that should I or my
successors assert a claim contrary to what I have agreed to in this contract,
the claiming party shall be liable for the expenses (including legal fees)
incurred by the Releasees in defending the claims.
This contract may not be modified orally, and a waiver or modification of
any provision shall not be construed as a waiver or modification of any other
provision herein or as a consent to any subsequent waiver or modification.
I consent to the release by any third party to Releasees and their
insurance carriers of my name and medical information that may relate solely to
any injury or death I may suffer arising from the event.
Every term and provision of this contract is intended to be severable.
If any one or more of them is found to be unenforceable or invalid, that
shall not effect the other terms and provisions, which shall remain binding and
enforceable.
_______________________________
______
Signature
of Entrant
Age
Consent and Release
of Parent or Guardian
I am the parent or guardian of ______________ (child) My
child is fit for the event, and I consent to my child’s participation.
I HAVE READ AND I
UNDERSTAND THE ABOVE CONTRACT. In
consideration of allowing my child to participate, I consent to the contract and
agree that ITS TERMS SHALL LIKEWISE
BIND ME, MY CHILD, my
heirs, legal representative, and assignees.
I HEREBY RELEASE AND SHALL
DEFEND, INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM EVERY CLAIM AND ANY
LIABILITY that I or my child may allege against the Releasees (including
reasonable legal fees and costs) as a direct or indirect result of injury or
death to me or my Child because of my childs participation in the event, WHETHER
CAUSED BY THE NEGLIGENCE OF THE RELEASEES or others.
I PROMISE NOT TO SUE RELEASEES
on my behalf or on behalf of my Child regarding any claim arising from my
Child’s participation in the event.
Signature of Parent or
Guardian
