Fill and Sign the Bicycle Form

Waiver and Release of Claims for Future Injuries or Death by an Adult Applying to Participate in a Bicycle Race In consideration of the acceptance of my application for entry in the ___________________________________ (Name and location of Bicycle Race), I, the undersigned, for myself, my heirs, executors, administrators and assigns (sometimes referred to herein jointly and severally as A Releasor @ ) hereby waive and release any and all claims for damages, for death or personal injury to me, and/or any loss of property or property damage I may have, or that may subsequently accrue to me, or to my heirs, executors, administrators or assigns, as a result of my participation in the _______________________________ (Name of Bicycle Race). Releasor does hereby discharge and release in advance the promoters, sponsors, volunteers, the promoting clubs, the event officials, and any towns and/or municipalities involved in or through which the race may cross, as well as their respective agents, boards, counsels, commissions, and any other involved municipalities, and employees and representatives of all of the foregoing, without limitation, from and any and all liability arising out of or connected in any way with my participation in the above- mentioned bicycle race, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. Releasor acknowledges that the _______________________________ (Name of Bicycle Race) is miles long and extends up and down hills. My participation is voluntary and done at my own risk. I voluntarily assume all risks of loss, damage or injury that may be sustained while participating in said race. I attest that I am physically fit and sufficiently trained for this kind of event. I agree that medical or other services rendered to me by, or at the instance of, any of the persons or entities mentioned above is not an admission of liability and is not a waiver by any of the persons or entities mentioned above of any right under this waiver and release. I further understand that serious accidents occasionally occur during bicycle racing, and that participants in bicycle racing occasionally sustain mortal or serious personal injuries or property damage as a consequence of such participation. Knowing the risks of bicycle racing, I nevertheless agree to assume those risks and to release and hold harmless all of the persons and entities mentioned above who, through negligence or carelessness or otherwise, might be liable to me (or my heirs, personal representatives or assigns) for damages. I attest that the bicycle and equipment I will use in this race are in good mechanical condition and suitable for use in the event. I understand that wearing a helmet can often prevent serious injury. I agree to accept and abide by the rules and regulations of the event as established and provided to me by the (officials or promoters of race and/or name of cycling authority) and to obey the directions of the designated officials. In further consideration of the acceptance of my application for entry in the _______________________________ (Name of Bicycle Race), I grant full permission to the (officials or promoters of race and/or name of cycling authority ) and their agents to use photographs, videotapes and any other record of the race, including my name, likeness and voice for any legitimate purpose. I have read and understand everything written above and I voluntarily sign this waiver and release. Helmets are strongly recommended for all riders . (If applicable, add: A and are mandated by state law @ ). Witness my signature this the day of , 20 . _________________________________ Signature of Releasor ______________________________ Witness to Signature