PLEASE COMPLETE THE FOLLOWING INFORMATION

Today’s Date __________________________________

Event Name Cycle De’ Cuse Swinburne Memorial Ride ­­­­­­

Event Date(s) 06/22/2014

Club/Team Name______________________________

Name _______________________________________

Address______________________________________

City___________________ State ______ Zip _______

Phone________________ E-mail _________________

Emergency Contact____________________________

Emergency Contact Phone _______________________

Age______  

How did you hear about the ride?

Radio: ___630 AM    ___107.9 FM     ___NPR

OCC: ___ email       ___ website

___ Flyer    ___Poster    ___Pennysaver 

bikeSyracuse: ___ Facebook ___ website

Other _______________________________________

 

I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT I AM ASSUMING RISKS, AND AGREEING TO INDEMNIFY, NOT TO SUE AND RELEASE FROM
LIABILITY THE ORGANIZER OF THIS EVENT AND THEIR RESPECTIVE AGENTS, EMPLOYEES, VOLUNTEERS, MEMBERS, CLUBS, SPONSORS,
PROMOTERS, AND AFLILATES (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 BIKE RIDES 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 registration payment by me, and the acceptance of my application for entry in the above event, I hereby freely agree to and make the following

contractual representations and agreements. I ACKNOWLEDGE THAT CYCLING IS AN INHERENTLY DANGEROUS SPORT AND FULLY RELAIZE THE DANGERS

OF PARTICIPATING IN

THIS EVENT, whether as a rider, official, coach, mechanic, or otherwise, and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by

way of example, and not limitation: dangers associated with man made and natural jumps; the dangers of collision with pedestrians, vehicles, other riders, and fixed or

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 RELEASEES’ 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, administration, legal representatives, assignees, and successors in interest (collectively “Successors”), I HEREBY WAIVE, RELEASE, DISCHARGE,

HOLD HARMLESS, AND PROMISE TO INDEMNIFY 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 employees through or by which the event will be held (the foregoing are also collectively deemed to be Releasees), FROM ANY AND ALL RIGHTS AND CLAIMS

INCLUDING CLAIMS ARISING FROM THE RELEASEES’ OWN NEGLIGENCE, which I have or which may hereafter accrue to me and from any and all damages which may

be sustained by my directly or indirectly in connection with, or arising out of, my participation in our 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 Releasees’ rules, and any special regulations for 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 provided for my use, and my conduct in connection with this event. I will wear a helmet which satisfies the requirements of the Releasees’ 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 myself or others if I participate in this event, or would interfere with my ability to safely participate in this event. I understand that drug testing

may be conducted for athletes registered for this event and that the use of blood boosting or substances prohibited by Releasees’ rules would make me subject to

penalties including, but not limited to, disqualification and suspension. I agree to be subject to drug testing if selected and its penalties if I fail to comply with the testing

or am found positive for the use of a banned substance.

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 affect the other terms and provisions, which shall remain binding and enforceable.

X_______________________________ ­­­______

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 representatives, 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 Child’s 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.

X _______________________________________

Signature of Parent or Guardian