2015 CASA Cycling for Children Acknowledgement of Risk jULY 25

2015 CASA Cycling for Children Acknowledgement of Risk
ACKNOWLEDGMENT OF RISK AND DUTY OF CARE
1. I am signing this document as a condition to my registration fee and participation in the Cycling for Children Bike Ride. My signature on this
document represents my express acknowledgment that the Cycling for Children Bike Ride in which I choose to participate involves inherent
and other risks and that I could suffer injury or death while participating. I also understand that I have the right and opportunity to investigate
and inspect facilities, equipment and areas to be used for the Cycling for Children Bike Ride, and, if I believe any of them are unsafe, I will
immediately advise the person supervising the event, activity, facility, or area.
2. I am voluntarily participating in the Cycling for Children Bike Ride with an understanding of the risks and despite the existence of the risks, I
choose to participate the in the Cycling for Children Bike Ride.
3. I acknowledge my personal responsibility to act reasonably under the particular circumstances of my participation. I agree to act responsibly
and reasonably. I acknowledge the application of the Montana Recreation Responsibility Act, Title 27, Chapter 1, Part 7, MCA.
4. I agree that this Agreement shall be governed by and interpreted solely in accordance with Montana law. Any litigation involving the parties
to this Agreement must be brought solely within the Montana State or Federal Courts, which shall have the exclusive jurisdiction over any
such cause.
5. In signing this Agreement, I am not relying on any oral or written representations or statements made by representatives of the Cycling for
Children Bike Ride, the local and national CASA organization, it’s employees, agents, volunteers, or representatives, other than what is set
forth in this Agreement.
6. I agree that photographs, pictures, slides, movies, or videos of me may be taken in connection with my participation in the Cycling for
Children Bike Ride without compensation from the local and national CASA organization, their officers, agents or employees and consent to
the use of these photographs, pictures, slides, movies, or videos for any purpose.
7. I warrant that I am in good health and have no physical condition that would prevent me from participating in the Cycling for Children Bike Ride.
8. I acknowledge that the local and national CASA organization, their officers, agents, volunteers, or employees are not joint sponsors, joint
venturers, partners, or otherwise jointly engaged in the above-named event or activity.
This document relieves the local and National CASA organization, their officers, agents or employees and
others from liability for personal injury, wrongful death, and property damage caused by negligence. I have
read this document, understand that I have given up substantial rights by signing it, and sign voluntarily.
PRINTED NAME
SIGNATURE
DATE
Parent/Guardian Signature (if participant under the age of 18)
Date
JULY 25, 2015 CASA Cycling for Children Registration Form
Name (print):__________________________________________________________________________________________________
Mailing Address:_______________________________________________________________________________________________
City/State/Zip:_________________________________________________________________________________________________
Email (for confirmation purposes):__________________________________________________________________________________
Phone:_______________________________ In case of an emergency notify:_______________________________________________
Registration Fee:
20 mile ride: $25 40 mile ride: $50 80 mile ride: $60 Late fee after July 22nd: $10
Optional Donation to CASA for Kids
$________
$________
$________
$________
$________
Total Enclosed:
$________
You will receive email confirmation for registration.
CASA for Kids
Online and paper registration is available. ($10 late fee after July 22).
• Online registration (www.GetMeRegistered.com/CyclingForChildren) closes July 22nd. Mail-in registration must be postmarked by July
22nd.• For paper registration mail completed form and check payable to: CASA for Kids, Inc and mail to: CASA for Kids,
Attn: Alicia Scofield, PO Box 11195, Kalispell, MT 59904
Packet Pick-up: Riders can pick up their packets from 4:00-6:30pm, Friday July 24 at Great Northern Cycles, 328 Central Ave, Whitefish,
MT or after 7:00am ride day at the start location.
Questions? Call Trish Bacsvany at 406-253-7320 or Alicia Scofield at 406-755-7208
Don’t Forget: 2015 Acknowledgement of Risk must be signed and sent with paper registration.