Green Lake Area Chamber of Commerce · 2018 Green Lake Bike 100

Contact Information

Name

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First Name

Last Name

Email

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Address

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Address Line 1

Address Line 2

City

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Phone

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How many riders are in your party?	Quantity
$55 - per rider

Will you have any children joining you on the ride?

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If yes, please indicate how many. If not, please indicate by entering "no" in the above box. Children younger than 17 ride free. Enter children aged 17 and under here. Children over 17 must be entered in the initial rider count above.

Release and Waiver of Liability, Assumption of Risk, and Idemnity

In consideration of being permitted to participate in any way in the Green Lake Bike 100 Ride, I, for myself, my personal representatives, assigns, heirs, and next of kin:

ACKNOWLEDGE, agree, and represent that I understand the nature of these activities and that I am qualified, in good health, and in proper physical condition to participate in such activity. I further acknowledge that the Green Lake Bike 100 Ride will be conducted over public roads and facilities open to the public 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.
FULLY UNDERSTAND that: (a) Bicycling involves 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 for others participating in the activity, the conditions 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 responsibility for losses, costs, and damages I incur as a result of my participation in the Green Lake Bike 100 Ride.
I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the Green Lake Bike 100, the Green Lake Area Chamber of Commerce or any of their administrators, directors, agents, officers, members, volunteers, employees, other participants, any sponsors, any advertisers, and, if applicable, owners and lessors of premises on which the activity takes place, (each considered to be "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 incure as the result of such claim.
I agree to obey all traffic laws and to wear adequate safety equipment during the Green Lake Bike 100 Ride.

By checking this box, you are stating you have read the above agreement, fully understand its terms, and will agree to the terms above.

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Yes, I agree.