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Release Applicant For Entry In Bicycle Racing Event

Waiver & Release

In consideration of the acceptance of my application for entry in the (specify bicycle event), I, the undersigned, for myself, my heirs, executors, administrators and assigns, hereby waive and release any and all claims for damages, for death, personal injury, loss of property or property damage I may have, or that may subsequently accrue to me, or to my heirs, executors, administrators or assigns, as a result of my participation in the (specify bicycle event).

I, the undersigned, discharge and release in advance the promoters, sponsors, volunteers, the promoting clubs, the event officials, (list cities and towns through which race will run) and any other municipalities involved, the (list counties through race will run), the State of (State), (list any special districts through which race will run, such as recreational districts or school districts), and their respective agents, boards, commissions, and any other involved municipalities, and employees and representatives of the foregoing, without limitation, (if applicable, add: and the specify cycling authority), from and any and all liability arising out of or connected in any way with my participation in the above-mentioned bicycle event, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.

I acknowledge that the (specify bicycle racing event) is (--) miles long and extends up and down hills. My participation is voluntary and done at my own risk. I voluntarily assume all risks of loss, damage or injury that may be sustained while participating in the above-mentioned event.

I attest that I am physically fit and sufficiently trained for this kind of event. I understand and agree that medical or other services rendered to me by, or at the instance of, any of the persons or entities mentioned above is not an admission of liability to provide or to continue to provide any such services, and is not a waiver by any of the persons or entities mentioned above of any right hereunder.

I further understand that serious accidents occasionally occur during bicycle racing, and that participants in bicycle racing occasionally sustain mortal or serious personal injuries andor property damage as a consequence thereof. Knowing the risks of bicycle racing, I nevertheless hereby agree to assume those risks and to release and hold harmless all of the persons and entities mentioned above who, through negligence or carelessness or otherwise, might be liable to me (or my heirs, personal representatives or assigns) for damages.

I attest that the bicycle and equipment I will use in the (specify bicycle racing event) are in good mechanical condition and suitable for use in the event.

I UNDERSTAND THAT WEARING A HELMET CAN PREVENT SERIOUS INJURY. I agree to accept and abide by the rules and regulations of the event as established and provided to me by the (name of cycling authority) and to obey the directions of the designated officials.

In further consideration of the acceptance of my application for entry in the (specify bicycle event), I hereby grant full permission to the (specify bicycle racing event) and/or agents authorized by the promoters, including (specify names of agents), to use photographs, videotapes and any other record of the (specify bicycle racing event), including my name, likeness and/or voice for any legitimate purpose.

I have read and understand everything written above and I voluntarily sign this waiver and release. Helmets are strongly recommended for all riders (if applicable, add: and are mandated by state law for infants and children under (eighteen) years of age).

THIS FORM IS INVALID WITHOUT A SIGNATURE.

(If applicable, here add: IF THE APPLICANT IS UNDER (18) YEARS OF AGE, THE (NOTARIZED) SIGNATURE OF A PARENT OF GUARDIAN OF THE APPLICANT IS REQUIRED.)

Dated:

Signature of Releasor

Signature of Parent/Guardian

Signature of Witness

(Acknowledgment of signature of parent or guardian, if required)

This Section for Notary:

Acknowledgment

STATE OF -------)

) ss: [date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

[signature]

[Name of Notary Public]

My commission expires: [date]

(Seal)