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 Your name goes here if you login 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 May 25, 2017 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_______________________