Gravel
Race Up Spruce Knob
ACCIDENT
WAIVER & RELEASE OF LIABILITY
RACE/RIDE
REGISTRATION FORM
This form must be
read carefully, filled out completely and signed by each participant and
volunteer.
DATE:
__________________
NAME: __________________________________
BIRTHDAY: _________________
GENDER: M [ ] F [
] CATEGORY: ___________ Bib#:
______ (Leave
blank if not yet assigned)
EMAIL ADDRESS: ____________________________________________________
STREET ADDRESS: __________________________________________________
CITY: ________________________________
STATE: ______ZIP: _______________
TEAM NAME:
________________________________________________________
PHONE#
(________)_________________________
EMERGENCY CONTACT: ___________________PH#
(______)________________
• 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 athletics, 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 the
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: MountainRides, LLC, The Mountain Institute, the U.S. National Forest
Service, 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 its contents.
Entrant’s Signature: _____________________________________
Date: ____________________
(Note: If entrant is age 17
or under, Signature of Parent or Guardian is required below) The undersigned
parent and natural guardian or legal guardian does hereby represent that he/she
is, in fact, acting in 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: ____________________
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