Contact Information

Name:
   Email Address: *   
   Phone Number: *   
Alternate Number:   
Address:
City / State / Zip:
Gender:
Age:
*Note:  Adults $40 each
             Children 15 and under $20 each
T-Shirt Size:

Ride Planned:
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CONSENT FORM

In order to ensure a safe and fun event for everyone, all riders must read the following waiver and sign where indicated. Minors (under age 18) must have completed minor consent also. In consideration of being permitted to participate in any way in the 2010 Ride for Health Bike Tour in partnership with The Maryland Wine Festival ® bicycling activities I, for myself or assigned heir, representative, or next of kin:

1. acknowledge, agree, and represent that I understand the nature of the activity and am qualified to participate.

2. fully understand that the activity involves risks and dangers of serious bodily injury, these risks and dangers may be caused by my own actions, or inactions, the action or inactions of others participating in the activity, the condition in which the activity takes place, or the negligence of the releases named below, there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time and I fully accept and assume all risks and responsibility for losses, cost and damages I incur as a result of my participation or that of the minor I have signed for in the activity.

3.hereby release, discharge, and covenant not to sue Access Carroll, Inc., their administrators, directors, agents, officers, members, volunteers, employees, other participants, any sponsors, advertisers, and if applicable, owner and lessors of premises on which the activity takes place from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise including negligent rescue operation; and, I further agree that if, despite the release and waiver of liability, assumption of risk and indemnity agreement, I or anyone on my behalf, makes a claim against any of the releases, I will indemnify, save, and hold harmless each of the releasees from any litigation expense, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

I have read this agreement, fully understand its terms, understand I have given up substantial rights by signing it, AND have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance notwithstanding, shall continue in full force and effect.
By agreeing below, I confirm that I have read and understand each of
the certifications, acknowledgements, and consents set forth above.
   
(if 18 or older) Type your full name here:
Date:    xx/xx/20xx

MINOR CONSENT

And I, the minor’s parent and/or legal guardian, understand the nature of the activity and the minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasees from all liability, claims, demand, losses, or damages on the minor’s account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the releasees named above, I will indemnify, save and hold harmless each of the releasees from any litigation expenses, attorney fees, loss of liability, damage or cost any many incur as a result of any such claim.

By agreeing below, I confirm that I have read and understand each of
the certifications, acknowledgements, and consents set forth above.
 
(if under 18) Type your full name here:
Parent/Guardian Name:
Date:    xx/xx/20xx