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 USA CYCLING, INC. (USAC), ITS ASSOCIATIONS (THE UNITED STATES
CYCLING FEDERATION (USCF),
NATIONAL OFF ROAD BICYCLE ASSOCIATION (NORBA),
NATIONAL COLLEGIATE CYCLING ASSOCIATION (NCCA),
U.S. PROFESSIONAL RACING ASSOCIATION (USPRO), AND
BMX ASSOCIATION (BMXA)), AND USA CYCLING DEVELOPMENT FOUNDATION (USACDF), 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 and make the
following contractual representations and agreements.
I ACKNOWLEDGE THAT CYCLING IS AN INHERENTLY DANGEROUS SPORT AND FULLY REALIZE
THE DANGERS OF PARTICIPATING IN THIS EVENT, whether as a rider, official, coach,
mechanic, volunteer,
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 or materials 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, administrators, 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 ANYAND 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 me directly or indirectly in connections 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
Releasees’ 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, any 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’ 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 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.
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, and our 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.
Signature of Parent or Guardian
ROAD/TRACK/CYCLOCROSS COMPETITIVE EVENT - 2009 USA Cycling Release Form AND One-Day License Application
TODAY'S DATE
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Fun Bike Race
ADDRESS
PHONE
RACE(S)/ACTIVITY(IES) ENTERED
STATE
ZIP
EVENT NAME
EVENT DATE(S)
NAME
CITY
RACING AGE (as of December 31, 2008)
Anytown
EMERGENCY CONTACT
EMERGENCY CONTACT PHONE
LICENSE #
PLEASE COMPLETE THE FOLLOWING INFORMATION
123456789
99
July 31, 2010
123 ABC Street
28203
WW
704-555-1212
Econ Name
704-555-1212
ONE-DAY PAYMENT INFORMATION
CASH
OR
CHECK ACCEPTED (no credit cards)
Competitive Event: $10 PER DAY
Amount Paid______________________________________________
Oneday Cat (R/T
5 men, 4 women; CX 4 all ) __________
Event Date(s)______________________________________________
Authorized Personnel Initials_______________________