1st Freeport Rail Trail Ride
Signature _____________________________________ (Parent’s
Signature if Rider under 18) Date________ (NOTE: By signing, you acknowledge
that you have read and agree to the conditions explained in the waiver printed
on this form.)
Printed Name____________________________________________________________________
Address______________________________________ Age on ride day _____
City___________________ State___ Emergency Contact ( ) ____---_______
Email Address___________________________________________________
In the consideration of the foregoing, I, for myself, my
heirs, executors, and administrators, waive and release all rights and claims
for damages against the 2015 Freeport to New Kensington Bicycle Ride,
principles, landowners where the ride crosses, all sponsors and volunteers from
claims against damages to my equipment in said ride, including and not limited
to any injuries I might suffer. I acknowledge that I am aware of the inherent
risks in participating in a bicycle ride. I attest and verify that I have
health insurance and that I am fit and am physically able for the riding of
this event, as certified by a licensed medical doctor. I agree to wear a helmet
while participating in this ride. I further consent to the use of my name,
image, and picture in advertising, promotion, or other account of this event in
the future.
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