| Name______________________________________________________
Rider#_________________________ |
| Address___________________________________________________________________________________ |
City__________________________State____________________
Zip____________
E-mail____________________________________________________________________Shirt
Size________ |
| |
Route ____30-mile
____62-mile
Pre-paid ____$30 After September 2nd
____$35____$10(Extra
T-shirt and
extra meal) |
| |
Waiver of Liability |
| I agree that it is my responsibility to obey
all applicable regulations, rules, and laws while participating in this event. I hereby
waive, release, and discharge any all claims for damages for death, personal injury or
property damage which I may have, or which may hereafter accrue to me as a result of my
participation in this bicycle tour conducted by the Hammond Kiwanis Club. This release is
intended to discharge in advance any claims for damage against the Hammond Kiwanis Club,
the City of Hammond, the Tangipahoa Sheriff's office, North Oaks Medical Center, Acadian
Ambulance Service, the Louisiana Massage Therapists Association, and any club member,
employee, agent or entity acting on thier behalf from and against all liabilities arising
out of or connected in any way with my participation in the bicycle tour or carelessness
on the part of the persons or entities mentioned above. I further understand thta serious
accidents may occur during bicycle tours and as a result participants in bicycle tours may
sustain mortal injuries, and/or property damage. Knowing the risks of bicycle riding,
nevertheless, I hereby assume those risks and to release and hold harmless all the persons
or entities mentioned above who might otherwise be liable to me or my heirs or assigns for
damages. It is further understood and agreed that this waiver, release and assumption of
risk is to be binding on my heirs and assigns. |
| RIDER'S
SIGNATURE______________________________________________DATE___________________ |
| |
| If you belong to a Bicycle Club, please
complete the information requested below: |
| Club
Name____________________________________________________________________ |
| Address__________________________________City____________________________Zip_____________ |
| Contact
Person_______________________________________Phone#_____________________________ |
