2015 SMART MONEY FAMILY FUN RIDE
LIABILITY WAIVER AND RELEASE
READ CAREFULLY BEFORE SIGNING
Benjamin Franklin Level
In signing this waiver for myself, or as legal guardian for the named
entrant if the entrant is under 18 years of age, I acknowledge that
I understand that by participating in the Smart Money Family
Fun Ride (“ride”) the entrant will be exposed to factors such as
traffic, other bicyclists, weather, animals, etc. whose actions are
beyond the control of the sponsors and organizers of the ride.
The entrant is voluntarily participating in the ride at their own risk.
In consideration of the entrant’s participation, the undersigned,
for the entrant, their heirs and administrators, agrees to assume
any and all risks which might be associated with the entrant’s
participation in the ride, and further waives and releases any and
all rights and claims for damages against, and absolves and holds
harmless, all of the sponsors, organizers and entities associated with
the ride, including but not limited to Centra Foundation and Centra
Credit Union, be they individuals, corporations, associations or
organizations, their respective officers, directors, agents, employees,
members, and successors, and any other parties connected with
this event whatsoever, from and against any blame, liabilities, harm,
loss, claims or actions from, proximately caused by or arising out of
any injury, damage, loss, expense, or inconvenience sustained or
suffered in conjunction with or arising out of participation in the
ride or any activities associated with the ride, including those claims
caused by the negligence of the released parties.
Ulysses S. Grant Level
“I UNDERSTAND THAT THE ENTRANT SHOULD WEAR A CPSC
APPROVED BICYCLING HELMET WHILE RIDING IN THE EVENT.”
I agree to follow all rules of the road, which apply to cars and
bicycles.
Riders under the age of 13 must be accompanied by an adult.
Adult/Parent/Guardian Name
_______________________________________________
Signature
_______________________________________________
Adult/Parent/Guardian Name
_______________________________________________
Signature
_______________________________________________
Names and ages of family members
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Date ___________________________
Bob Poynter Columbus
Centra Credit Union
Haddad Foundation
CUNA Mutual Group
HNE Printing
Kenny Glass, Inc.
Kirr, Marbach & Company, LLC
The Republic
Q-mix
Andrew Jackson Level
Chevrolet of Columbus
College Saving Bank
Elwood Staffing
Meridian Title Corporation
Taylor Bros. Construction Co., Inc.
IN A
U G U R AL
Alexander Hamilton Level
Acra Automotive Group
Aton’s Self Storage
Ash Brokerage
Audio Magic Entertainment
Columbus Regional Health
The Degner Family
Dove Data Products
Ann and Steve Heimann
Joy of Giving
LHP
Manpower
Muscatatuck Association of Realtors
Pia O’Connor
Reams Asset Management
SIHO Insurance Services
Sharpnack Bigley Stroh & Washburn LLP
Saturday, June 20, 2015
Columbus Learning Center
4555 Central Avenue
Abraham Lincoln Level
A Thyme For All Seasonings
Arby’s Edinburgh
Todd and Deb Burbrink
Coca-Cola Bottling Co.
Columbus Cycling and Fitness
Cornerstone Development
The Bicycle Station
Gil Palmer State Farm Insurance
Milestone Contractors, L.P.
Office 360°
Parker Portraits
Remax Real Estate Professionals
Renner Motors
Voelz Body Shop, Inc.
Warren Ward Associates
And our Activity Station Hosts!
Atterbury-Bakalar Air Museum
Columbus Bicycle Co-op
Emily Kim
IUPUC Division of Education
Reach Healthy Communities
Main Ride – 14 miles
Rolling Start between
8:30 a.m. – 9:30 a.m.
Short Ride – 5 miles
Rolling Start between
8:45 a.m. - 10:30 a.m.
A fun family friendly bike ride with
prizes and activities along the way!
The Smart Money Family Fun Ride will raise funds to support
and expand Centra Foundation’s financial literacy programs in
Bartholomew and surrounding counties schools.
LEARN
The ride offers age related activities and
questions at stops along the route. Learn
about money and how to use it wisely!
Activities will help children Save, Share and
Spend, while teens and adults will learn
about saving for college and retirement.
WIN GREAT PRIZES
Our grand prize for riders 4-8 years is
a Leap pad. Older children and adults
could win a Kindle. There will be plenty
of other prizes too! Drawing for prizes at
start/finish line at 1:00 p.m..
RIDE
The main route uses the People Trail.
Stops include North High School, Mill
Race, Lincoln Parks and the Atterbury
Bakalar Air Museum.
The short route is designed for young
children and walkers. The route will
follow Middle Road and Rocky Ford Road,
joining the main route at Marr Road.
Registration Form
Name_________________________________________
Address_______________________________________
City/State/Zip___________________________________
Email_________________________________________
Phone________________________________________
Early Bird Registration through May 29
5 Youth 4 - 13 years - Includes drawstring backpack
25 High School/Adult - Includes T-shirt
$
$
Select ADULT T-Shirt Size
▢ Small ▢ Medium ▢ Large ▢ X-Large ▢ XXL
After May 29
10 Youth 4 - 13 years
35 High School/Adult
$
$
T-shirts and backpacks not guaranteed
Number of Riders/Entry Fee
Adult(s) _______________ ▢ Early Bird Total $_______
4-8 Youth______________ ▢ Early Bird Total $_______
9-13 Youth_____________ ▢ Early Bird Total $_______
SIZE & QUANTITY
Additional T-Shirts - $10 Each_______________________
Total Amount Enclosed: $__________________________
SIGN & DATE YOUR WAIVER ON THE BACK OF YOUR FORM!
ALL RIDERS MUST HAVE A SIGNED WAIVER.
RAISE AWARENESS
Additional prizes will be given for
riders who collect the most pledges
from friends and family to support
financial literacy education!
Download the Fundraising form at
Centrafoundation.org
Mail Registrations to:
Centra Foundation
P.O. Box 789
Columbus, IN 47202
Register online at Centrafoundation.org
MORE THAN JUST A BIKE RIDE!