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Make checks payable to: Spring City Spinners Bicycle Club
Mail to: Spring City Spinners, P.O. Box 2055, Waukesha, WI 53187-2055
2008
PEDAL THE KETTLE
– WEB APPLICATION
NAME(S):_____________________________________________________________
ADDRESS:_____________________________________________________________
CITY:_________________STATE:____
ZIP CODE: _________DATE:____________
PHONE:_____________________
E-MAIL:__________________________________
Anticipated
Mileage: (circle
one) 33 66 102 miles
How did
you hear about our
ride? ____________________________________
|
|
Before
9/1/07 |
After
9/1/07 |
Qty. |
Total |
|
Ride
Fee (Not
incl. T-Shirt) |
$20 |
$25 |
|
$ |
|
12
Years & Under |
Free |
Free |
|
|
|
Long
Sleeve T-Shirt ( M L
XL or XXL Circle
size requested) |
$15 |
N/A |
|
$ |
|
TOTAL: |
|
|
|
$ |
LEAGUE
OF AMERICAN
WHEELMEN d/b/a LEAGUE OF AMERICAN BICYCLISTS ("LAB") RELEASE AND WAIVER
OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT
AGREEMENT
("AGREEMENT")
IN
CONSIDERATION of being
permitted to participate in any way in the Spring City Spinners Bicycle
Club
("Club") sponsored Bicycling Activities ("Activity") I, for
myself, my personal representatives; assigns, heirs, and next of kin:
1.
ACKNOWLEDGE, agree, and
represent that I understand the nature of Bicycling Activities and that
I am
qualified, in good health, and in proper physical condition to
participate in
such Activity. I further acknowledge that the Activity will be
conducted over
public roads and facilities open to the public during the Activity and
upon
which the hazards of traveling
are to be expected. I
further agree and warrant that if at any time I believe conditions to
be
unsafe, I will immediately discontinue further participation in the
Activity.
2.
FULLY UNDERSTAND that: (a)
BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY
INJURY,
INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b)
these Risks and dangers may be caused by my own actions or inactions,
the
actions or inactions of others participating in the Activity, the
condition in
which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES"
NAMED BELOW; (c) 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 SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND
DAMAGES I
incur as a result of my participation or that of the minor in the
Activity.
3.
HEREBY RELEASE, DISCHARGE,
AND COVENANT NOT TO SUE the Club, the LAB, their respective
administrators,
directors, agents, officers, members, volunteers, and employees, other
participants, any sponsors, advertisers, and, if applicable, owners and
lessors of premises on
which the Activity takes place,
(each considered one of the "RELEASEES" herein) 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 OPERATIONS; AND I FURTHER AGREE
that if,
despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND
INDEMNITY
AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY,
SAVE, AND HOLD HARMLESS EACH
OF THE RELEASEES from any litigation expenses, 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 THAT 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.
PRINTED
NAME OF PARTICIPANT:______________________________________________
ADDRESS:__________________________________________________________________
(Street)
(City) (State)
(Zip)
PHONE:______________________________
PARTICIPANTS
SIGNATURE (only
if age 18 or over):
_______________________DATE:___________
MINOR
RELEASE:
AND I,
THE MINOR'S PARENT ANDIOR
LEGAL GUARDIAN, UNDERSTAND THE NATURE OF BICYCLING ACTIVITIES AND THE
MINOR'S
EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN
GOOD
HEALTH, AND IN PROPER PHYSICAL CONDITION 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 RELEASEE'S FROM ALL LIABILITY, CLAIMS,
DEMANDS,
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 U(PENSES, ATTORNEY FEES, LOSS
LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH
CLAIM.
PRINTED
NAME OF
PARENT/GUARDIAN:_________________________________________________________
ADDRESS:_________________________________________________________________
(Street)
(City) (State)
(Zip)
PHONE:
________________________
PARENT/GUARDIAN
SIGNATURE
(only
if
participant is under age 18):_________________________________________DATE:
______________
Mail
to and make checks
payable to:
SPRING CITY SPINNERS BICYCLE CLUB, P.O. BOX 2055, WAUKESHA, WI 53187-2055